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3924_FM_i-xviii 29/11/13 1:42 PM Page i
Pediatric Success
A Q&A Review Applying Critical Thinking
to Test Taking
SECOND EDITION
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Pediatric Success
A Q&A Review Applying Critical Thinking
to Test Taking
SECOND EDITION
Beth Richardson, PhD, RN, CPNP, FAANP
Associate Professor Emeritus
Indiana University School of Nursing
Indianapolis, Indiana
Pediatric Nurse Practitioner
HealthNet
Indianapolis, Indiana
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F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2014 by F. A. Davis Company
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Printed in the United States of America
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Director of Content Development: Darlene D. Pedersen
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As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date,
and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for
errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard
to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised
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I thank my children, Jason, Sarah, and Walker; my grandchildren, Caroline, Darren,
and Sadie; and my friends, especially David, for all their love and support.
To students, graduates, and colleagues: thank you for all you do in caring for children
and their families.
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Contributor
Susan P. Wade, MSN, RN, CPN, CCRN
Clinical Assistant Professor
Indiana University
Purdue University
Fort Wayne, Indiana
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Contributors to
Previous Edition
Sherrilyn Coffman, DNS, RN, CPN
Professor and Assistant Dean
Nevada State College
Henderson, Nevada
Dawn Marie Daniels, DNS, RN, PHCNS-BC
Clinical Nurse Specialist
Riley Hospital for Children
Indianapolis, Indiana
Mary Jo Eoff, RN, MSN, CPNP
Clinical Instructor
Indiana University
Indianapolis, Indiana
Joyce Foresman-Capuzzi, BSN, RN, CEN, CPN, CCRN, CTRN,
CPEN, SANE-A, EMT-P
Clinical Nurse Educator/Emergency Department
Lankenau Hospital
Wynnewood, Pennsylvania
Paige Johnson, RN, MSN, MPH, CRNP
Pediatric Nurse Practitioner
Children’s Mercy Hospital, Department of Hematology/Oncology
Kansas City, Missouri
Dominique Leveque, MSN, RN, CPNP, FNP-C
Workplace Health Services
Clarian Health Partners
Indianapolis, Indiana
Christina Bittles McCarthy, MSN, RN, CPNP
Pediatric Nurse Practitioner
Indiana University, Department of Orthopedic Surgery
Indianapolis, Indiana
Patricia A. Normandin, RN, MSN, CEN, CPN, CPEN, DNP(c)
Pediatric Nursing Instructor
University of Massachusetts, Lowell
Lowell, Massachusetts
Julie A. Poore, RN, MSN
Visiting Lecturer
Indiana University
Indianapolis, Indiana
ix
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x
CONTRIBUTORS
TO
PREVIOUS EDITION
Susan P. Wade, MSN, RN, CPN, CCRN
Clinical Assistant Professor
Indiana University
Purdue University
Fort Wayne, Indiana
Cele Walter, BSN, RN, CPN, NCSN
High School Nurse
Paul VI High School
Haddonfield, New Jersey
Candace F. Zickler, CPNP, RN, MSN
Supervisor, Health Services
Metropolitan School District of Perry Township
Indianapolis, Indiana
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Reviewers
Jacoline Sommer Albert, ADN, RN, BScN, DI
Senior Instructor
The Aga Khan University
Karachi, Pakistan
Monique Alston-Davis, MSN, Ed, CPN
Assistant Professor
Montgomery College
Silver Spring, Maryland
Cathryn J. Baack, PhD, RN, CPNP
Assistant Professor
MedCentral College of Nursing
Mansfield, Ohio
Joyce Beard, MSN, PHCNS-BC, NCSN, RN
Assistant Clinical Professor
University of North Carolina, Pembroke
Pembroke, North Carolina
Vicky H. Becherer, MSN, RN
Assistant Teaching Professor
University of Missouri, St. Louis
St. Louis, Missouri
Stacee Bertolla, RN, MSN, CPNP
Instructor
University of South Alabama
Mobile, Alabama
María del Rosario C. Biddenback, RN, MSN, FNP-C
Professor
Napa Valley College
Napa, California
Kathleen Borge, MS, RNC
Faculty Chair, Women and Children’s Health
Samaritan Hospital
Troy, New York
Pam Bowden, RN, MS, PNP
Faculty
North Hennepin Community College
Brooklyn Park, Minnesota
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REVIEWERS
Twila J. Brown, PhD, RN
Assistant Professor
Southeast Missouri State University
Cape Girardeau, Missouri
Katherine Bydalek, MSN, FNP-BC, PhD
Assistant Professor
University of South Alabama
Mobile, Alabama
Dena Christianson, MSN, PNP
Adjunct Faculty
Nova Southeastern University
Fort Lauderdale, Florida
Karen Clancy, MS, RN, CNP
Clinical Instructor
Ohio State University
Neonatal Nurse Practitioner
Columbus Children’s Hospital
Columbus, Ohio
Myra L. Clark, MS, FNP-C
Assistant Professor
North Georgia College and State University
Dahlonega, Georgia
Lori Clay, MSN, RN
Assistant Professor
Arkansas State University
Jonesboro, Arkansas
Sallie Coke, PhD, APRN, CPNP, CFNP
Associate Professor
Georgia College and State University
Milledgeville, Georgia
Georgina Colalillo, MS, RN, CNE
Associate Professor, Nursing Department
Queensborough Community College
Bayside, New York
Judith Drumm, DNS, RN, CPN
Professor/Nursing
Palm Beach Atlantic University
West Palm Beach, Florida
Elizabeth Fiske, PhD, RN, NNP-BC, PCNS, BC
Associate Professor
Carson-Newman University
Jefferson City, Tennessee
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REVIEWERS
Jennifer Bell Frank, MSN, APRN, BC
Instructor
Jacksonville State University
Jacksonville, Alabama
Marianne Fraser, MSN, RN, BC
Assistant Professor
University of Utah
Salt Lake City, Utah
Susan Golden, MSN, RN
Nursing Faculty
Eastern New Mexico University, Roswell
Roswell, New Mexico
Heather Janiszewski Goodin, PhD, RN, AHN-BC
Professor
Capital University
Columbus, Ohio
Kathy L. Ham, RN, EdD
Assistant Professor
Southeast Missouri State University
Cape Girardeau, Missouri
Brenda J. Walters Holloway, APRN, FNP, DNSc
Clinical Assistant Professor
University of South Alabama
Spanish Fort, Alabama
Teresa L. Howell, DNP, RN, CNE
Associate Professor of Nursing
Morehead State University
Morehead, Kentucky
Mary C. Kishman, PhD, RN
Associate Professor
College of Mount St. Joseph
Cincinnati, Ohio
Katherine R. Kniest, RN, MSN, CNE
Professor
William Rainey Harper College
Palatine, Illinois
Robyn Leo, MSN
Associate Professor
Worcester State College
Worcester, Massachusetts
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REVIEWERS
Barbara J. MacDougall, MSN, ARNP
Nova Southeastern University
Ft. Lauderdale, Florida
Sheila Matye, MSN, RN, CNE
Associate Clinical Professor
Montana State University, College of Nursing
Great Falls, Montana
Kathleen T. Mohn, RN, MSEd, CLNC
Instructor
College of Southern Nevada
Las Vegas, Nevada
Jennifer Morton, MS, MPH, RN
Assistant Professor
University of New England
Portland, Maine
Irene Owens, MSN, APRN
Instructor
Lake Sumter Community College
Leesburg, Florida
Brenda Pavill, RN, FNP, PhD, IBCLC
Professor
Misericordia University
Dallas, Pennsylvania
Delia Pittman, PhD
Nursing Professor
MidAmerica Nazarene University
Olathe, Kansas
Janine T. Reale, MS, RN, CNE
Instructor, Nursing Faculty
Rivier University
Nashua, New Hampshire
Deborah A. Roberts, RN, BSN, MSN, EdD
Instructor
Sonoma State University, Department of Nursing
Sonoma, California
Rebecca L. Shabo, RN, PNP-BC, PhD
Associate Professor
Kennesaw State University
Kennesaw, Georgia
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REVIEWERS
Cynthia A. Shartle, RN, MSN, APRN, BC-FNP
ADN Faculty
South Texas College
McAllen, Texas
Patsy M. Spratling, RN, MSN
Nursing Instructor
Holmes Community College
Ridgeland, Mississippi
Linda Strong, MSN, RN, CPNP, CNE
Assistant Professor, Pediatric Nursing
Cuyahoga Community College
Cleveland, Ohio
Bev Valkenier, BScN, RN, MSN
Lecturer
University of British Columbia
Vancouver, British Columbia, Canada
Linda Walters, RN, MSN, PhD (a.b.d.)
Nursing Instructor
Indiana State University
Terre Haute, Indiana
Elizabeth M. Wertz, RN, BSN, MPM, EMT-P, PHRN, FACMPE
Chief Executive Officer
Pediatric Alliance, PC
Carnegie, Pennylvania
Sarah Whitaker, DNS, RN
Nursing Program Director
Dona Ana Community College
Las Cruces, New Mexico
Barbara White, RN, MSN, CCRN
Nursing Instructor
Southwestern Michigan College
Dowagiac, Michigan
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Contents
1
Fundamentals of Critical Thinking Related to
Test Taking: The RACE Model ......................................................................................01
HOW TO USE THIS REVIEW BOOK ..............................................................................................01
2
Growth and Development .................................................................................................05
KEYWORDS ..........................................................................................................................................05
ABBREVIATIONS ................................................................................................................................05
QUESTIONS .........................................................................................................................................05
ANSWERS AND RATIONALES ........................................................................................................15
3
Issues Related to Pediatric Health ...........................................................................27
KEYWORDS ..........................................................................................................................................27
ABBREVIATIONS ................................................................................................................................27
QUESTIONS .........................................................................................................................................28
ANSWERS AND RATIONALES ........................................................................................................37
4
Respiratory Disorders ...........................................................................................................51
KEYWORDS ..........................................................................................................................................51
ABBREVIATIONS ................................................................................................................................51
QUESTIONS .........................................................................................................................................52
ANSWERS AND RATIONALES ........................................................................................................61
5
Neurological Disorders ........................................................................................................75
KEYWORDS ..........................................................................................................................................75
ABBREVIATIONS ................................................................................................................................75
QUESTIONS .........................................................................................................................................76
ANSWERS AND RATIONALES ........................................................................................................85
6
Cardiovascular Disorders ...................................................................................................97
KEYWORDS ..........................................................................................................................................97
ABBREVIATIONS ................................................................................................................................97
QUESTIONS .........................................................................................................................................97
ANSWERS AND RATIONALES ......................................................................................................105
7
Hematological or Immunological Disorders ....................................................115
KEYWORDS .......................................................................................................................................115
ABBREVIATIONS ..............................................................................................................................115
QUESTIONS ......................................................................................................................................116
ANSWERS AND RATIONALES ......................................................................................................124
8
Gastrointestinal Disorders..............................................................................................135
KEYWORDS .......................................................................................................................................135
ABBREVIATIONS ..............................................................................................................................136
QUESTIONS ......................................................................................................................................136
ANSWERS AND RATIONALES ......................................................................................................146
xvii
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xviii
CONTENTS
9
Genitourinary Disorders ................................................................................................157
KEYWORDS ....................................................................................................................................157
ABBREVIATIONS ..........................................................................................................................157
QUESTIONS ...................................................................................................................................158
ANSWERS AND RATIONALES ..................................................................................................167
10
Endocrine Disorders ........................................................................................................177
KEYWORDS ....................................................................................................................................177
ABBREVIATIONS ..........................................................................................................................177
QUESTIONS ...................................................................................................................................178
ANSWERS AND RATIONALES ..................................................................................................188
11
Neuromuscular or Muscular Disorders.............................................................199
KEYWORDS ....................................................................................................................................199
ABBREVIATIONS ..........................................................................................................................199
QUESTIONS ...................................................................................................................................199
ANSWERS AND RATIONALES ..................................................................................................209
12
Orthopedic Disorders ......................................................................................................219
KEYWORDS ....................................................................................................................................219
ABBREVIATIONS ..........................................................................................................................219
QUESTIONS ...................................................................................................................................219
ANSWERS AND RATIONALES ..................................................................................................229
13
Leadership and Management ..................................................................................239
KEYWORDS ....................................................................................................................................239
ABBREVIATIONS ..........................................................................................................................239
QUESTIONS ...................................................................................................................................239
ANSWERS AND RATIONALES ..................................................................................................249
14
Pharmacology .......................................................................................................................263
KEYWORDS ....................................................................................................................................263
ABBREVIATIONS ..........................................................................................................................264
CONVERSIONS .............................................................................................................................264
QUESTIONS ...................................................................................................................................264
ANSWERS AND RATIONALES ..................................................................................................272
15
Comprehensive Exam .....................................................................................................281
QUESTIONS ...................................................................................................................................281
ANSWERS AND RATIONALES ..................................................................................................296
Glossary of English Words Commonly Encountered on Nursing
Examinations ...........................................................................................................................................313
Index
.........................................................................................................................................................317
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1
Fundamentals of Critical
Thinking Related to Test
Taking: The RACE Model
Pediatric Success: A Q&A Review Applying Critical Thinking to Test Taking is designed to help
you, the student, complete your nursing program as well as succeed on the NCLEX–RN®
examination.
This book applies critical thinking skills primarily to multiple choice questions and to
some alternate test items. It provides practice test questions and test-taking hints to help
you analyze each item and choose the correct response.
Another book in the Success series, Fundamentals Success by Nugent and Vitale, explains
critical thinking and the RACE Model, which are used in each book in the series. This information will help you answer questions on tests in your nursing courses and on the
NCLEX-RN examination. The key to successful studying is knowing the material that will
be covered on the examinations. Course notes should be studied every night and corresponding readings done before class. This will help you learn the material and retain it
longer. Once you know the material, it is important for you to be able to answer primarily
multiple choice questions correctly. The RACE Model will help you succeed with answering questions.
HOW TO USE THIS REVIEW BOOK
The book contains 14 chapters, a final comprehensive examination, and practice questions
online. Test-taking hints are included with each question.
This chapter provides guidelines for course test preparation and includes an example of
how to use the RACE Model.
Chapter 2 focuses on growth and development of children from infancy through
adolescence. Chapter 3 covers material on issues related to pediatric health. Chapters 4
through 12 follow pediatric health problems through each of the body systems. Each
chapter contains practice questions, answers, and rationales for the correct answer, including test-taking hints, keywords, and abbreviations.
Chapter 13, “Leadership and Management,” relates to pediatric nursing. Chapter 14,
“Pharmacology,” has been included because of the expressed need of students for extra testing
in this area. In the NCLEX-RN test plan (www.ncsbn.org), pharmacology and management of
care have a large number of test items. Graduates need to have a working knowledge of issues
in these areas. This chapter includes questions centered on what the student nurse caring for
children of all ages needs to know about administering medications, drug actions, dosages,
expected effects, adverse effects, and teaching families.
Chapter 15 is a final 100-question comprehensive examination. There are also two
100-question exit examinations available online. You can take the online tests prior to the
final exam if you wish. Questions in this book are written primarily at the application and
analysis level and are either multiple-choice, with four response choices, or alternate-item
format. Nursing faculty members write tests in these formats to familiarize students with
the NCLEX-RN examination style.
1
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2
PEDIATRIC SUCCESS
Test Preparation
One of the most important strategies for you is to study your course materials thoroughly
and know the assigned concepts for each examination in your class. It is best to study daily
so that you really learn the material. Don’t wait and try to learn it all at one time. The more
time you spend studying the topic, the better you will retain the material.
After you feel confident that you know the material, choose the chapter(s) in this book
that correspond(s) with the assigned test material in your nursing course. Answer the practice questions to determine your level of knowledge about the topic. Carefully review the
questions you miss, making sure you read and understand the rationale for choosing the
wrong distracter and why the correct response is indeed correct. The rationales provide a
great deal of information about the correct and incorrect options, which helps you understand the content better. The test-taking hints are strategies to help you logically determine
the correct response. If you still feel uncomfortable with the content area, review that
chapter in your textbook for better understanding. This method of preparing for an examination will help you identify your strengths and areas to focus on as you continue to study.
You may want to start with the Chapter 14, “Pharmacology,” because you will be administering medications to children throughout your pediatric nursing course. This chapter
will help you focus on teaching strategies for families of children receiving medications,
differences in delivering drugs to children, and calculating dosages.
RACE Model
The RACE Model is a critical thinking strategy to be used when answering multiple
choice questions. The RACE Model helps you analyze the question stem and determine
the correct response. For more detailed information about the RACE Model, see Test
Success: Test-Taking Techniques for Beginning Nursing Students by Nugent and Vitale.
The RACE Model comprises:
R
A
C
E
-
Recognize the keywords in the stem.
Ask what the question is asking the nurse to do.
Critically analyze each option in relation to the information in the stem.
Eliminate as many options as possible to narrow your choice to the correct response.
Some students believe they know the material but have difficulty choosing the correct
response when answering multiple choice questions. Using the RACE Model will greatly
increase your chances of choosing the correct response. To use it effectively during
timed tests, you need to practice. Using the RACE Model as you prepare yourself with
the chapter tests will help you. Following is a sample question:
1. A 6-month-old is being seen in the clinic for a well-child checkup. The parents want to
know about starting solid foods. How should the nurse counsel them?
1. “Since you started rice cereal from a spoon 2 months ago, you can add a new
strained vegetable each week.”
2. “Introduce some mashed fruits first. After the infant is eating that well, start
vegetables and rice cereal.”
3. “Infants do best eating solids if you spoon-feed a new strained vegetable every other
day to see what their preferences are.”
4. “Add rice cereal to each bottle. Next you can add fruits and vegetables fed by
spoon.”
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CHAPTER 1 FUNDAMENTALS
OF
CRITICAL THINKING RELATED
TO
TEST TAKING: THE RACE MODEL
Using the RACE Model:
R - The client in the stem is the parent.
A - The parents want to know how to add solid foods to their infant’s diet.
C - Infants start rice cereal between 4 and 6 months. This is fed to the infant by spoon
unless there is an indication to place it in the bottle. That is not stated in the stem of
this question. Either strained fruits or vegetables are added to the infant’s diet at
about 6 months of age. The infant stays on that choice for several days to determine
if the infant is allergic.
E - Now you can eliminate choices 2, 3, and 4 because they do not contain choices that
you know are correct. The remaining choice is 1, the correct response.
3
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2
Growth and Development
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Anemia
Auscultate
Autonomy
Dehydration
Detachment
Gynecomastia
Hepatitis B
Industry
Inguinal hernia
Initiative
Palpate
ABBREVIATIONS
Atrial septal defect (ASD)
Emergency department (ED)
Face, legs, action, consolability,
crying (FLACC)
Failure to thrive (FTT)
Intramuscular (IM)
Intravenous (IV)
Nothing by mouth (NPO)
Ounce (oz)
Pound (lb)
QUESTIONS
Infants
1. A 6-month-old male is at his well-child checkup. The nurse weighs him, and his
mother asks if his weight is normal for his age. The nurse’s best response is:
1. “At 6 months his weight should be approximately three times his birth weight.”
2. “Each child gains weight at his or her own pace.”
3. “At 6 months his weight should be approximately twice his birth weight.”
4. “At 6 months a child should weigh about 10 lb more than his or her birth weight.”
5
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6
PEDIATRIC SUCCESS
2. How can the nurse best facilitate the trust relationship between infant and parents
while the infant is hospitalized? The nurse should:
1. Encourage the parents to remain at their child’s bedside as much as possible.
2. Keep parents informed about all aspects of their child’s condition.
3. Encourage the parents to hold their child as much as possible.
4. Advise the parents to participate actively in their child’s care.
3. The nurse is going to give a 6-month-old a dose of Rocephin IM. What must the
nurse do when the 1.5-mL dose arrives from the pharmacy?
1. Administer the injection into the deltoid muscle.
2. Divide the dose into two injections.
3. Administer the injection into the dorsogluteal muscle.
4. Give dose as a single injection into the vastus lateralis muscle.
4. Which statement by an infant’s mother leads the nurse to believe that she needs
further education about the nutritional needs of a 6-month-old?
1. “I will continue to breastfeed my son and will give him rice cereal three times
a day.”
2. “I will start my son on fruits and gradually introduce vegetables.”
3. “I will start my son on carrots and will introduce one new vegetable every
few days.”
4. “I will not give my son any more than 8 ounces of baby juice per day.”
5. Which statement accurately describes the best method for assessing a 12-month-old?
1. The nurse should assess the child on the examining table.
2. The nurse should assess the child in a head-to-toe sequence.
3. The nurse should have the child’s mother assist in holding her down.
4. The nurse should assess the child while she is in her mother’s lap.
6. The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which statement reflects a
need for further education of the new mother?
1. “I will use only breast milk or an iron-fortified formula as a source of milk for my
baby until she is at least 12 months old.”
2. “My baby will need to have iron supplements introduced when she is
4 months old.”
3. “I will need to add iron supplements to my baby’s diet when she is 2 months old.”
4. “When my baby begins to eat solid foods, I should introduce iron-fortified cereals
to her diet.”
7. A first-time mother brings in her 5-day-old baby for a well-child visit. The nurse
weighs the infant and reports a weight of 7 lb 5 oz to the mother. The mother
looks concerned and tells the nurse that her baby weighed 7 lb 10 oz when she
was discharged 4 days ago. The nurse’s best response to the mother is:
1. “I will let the doctor know, and he will talk with you about possible causes of your
infant’s weight loss.”
2. “Al weight loss of a few ounces is common among newborns, especially for breastfeeding mothers.”
3. “I can tell you are a first-time mother. Don’t worry; we will find out why she is
losing weight.”
4. “Maybe she isn’t getting enough milk. How often are you breastfeeding her?”
8. Which toy is the best choice for a 12-month-old?
1. Baby doll.
2. Musical rattle.
3. Board book.
4. Colorful beads.
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CHAPTER 2 GROWTH
AND
DEVELOPMENT
9. The parents of a newborn are asking the nurse how to use the infant car seat and
where it should be placed in their vehicle. Which is the next most appropriate action
by the nurse?
1. Give the parents a pamphlet explaining how to install the car seat.
2. Accompany the parents to the car, and show them how to install the car seat.
3. Contact the hospital’s car-seat safety officer, and ask the officer to accompany the
parents to the car for car-seat installation.
4. Show the parents a video on car-seat installation and safety, and ask if they are
comfortable with the information.
10. The mother of a newborn asks the nurse when the infant will receive the first
hepatitis B immunization. Which is the nurse’s best response?
1. “Babies receive the hepatitis B vaccine only if their mother is hepatitis B–positive.”
2. “The first dose of the hepatitis B vaccine will be given prior to discharge today.”
3. “The first dose of hepatitis B vaccine is given at 1 year of age.”
4. “Babies receive their first hepatitis B vaccine at 6 months of age.”
11. Which finding would the nurse consider abnormal when performing a physical
assessment on a 6-month-old?
1. Posterior fontanel is open.
2. Anterior fontanel is open.
3. Beginning signs of tooth eruption.
4. Able to track and follow objects.
12. A mother requests that her child receive the varicella vaccine at the 9-month
well-child checkup. The nurse tells the mother that:
1. Children who are vaccinated will likely develop a mild case of the disease.
2. The vaccine cannot be given at that visit.
3. The vaccine will be administered after the physician examines the child.
4. A booster vaccination will be needed at 18 months of age.
13. What should parents understand is one of the most common causes of injury and
death for a 7-month-old infant?
1. Poisoning.
2. Child abuse.
3. Aspiration.
4. Dog bites.
14. An 8-day-old was admitted to the hospital with vomiting and dehydration. The
newborn’s heart rate is 170, respiratory rate is 44, blood pressure is 85/52, and
temperature is 99°F (37.2°C). What is the nurse’s best response to the parents who
ask if the vital signs are normal?
1. “The blood pressure is elevated, but the other vital signs are within normal limits.”
2. “The temperature is elevated, but the other vital signs are within normal limits.”
3. “The respiratory rate is elevated, but the other vital signs are within normal limits.”
4. “The heart rate is elevated, but the other vital signs are within normal limits.”
15. The mother of an 11-month-old with iron deficiency anemia tells the nurse that her
infant is currently taking iron and a multivitamin. Which statement made by the
mother should be of concern to the nurse?
1. “I give the iron and multivitamin at the same time each morning.”
2. “I give the iron and multivitamin in the morning 6-oz bottle.”
3. “I give the iron and multivitamin 2 hours before I feed the morning bottle.”
4. “I give the iron and multivitamin in oral syringes toward the back of the cheek.”
16. The nurse is using the FLACC scale to rate the pain level in a 9-month-old. Which
is the nurse’s best response to the father’s question of what the FLACC scale is?
1. “It estimates a child’s level of pain utilizing vital sign information.”
2. “It estimates a child’s level of pain based on parents’ perception.”
3. “It estimates a child’s level of pain utilizing behavioral and physical responses.”
4. “It estimates a child’s level of pain utilizing a numeric scale from 0 to 5.”
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17. A 12-month-old boy weighed 8 lb 2 oz at birth. Understanding developmental milestones, what should the nurse caring for the child expect the current weight to be?
1. 16 lb 4 oz
2. 20 lb 5 oz
3. 24 lb 6 oz
4. 32 lb 8 oz
18. The nurse is assessing the pain level in an infant who just had surgery. The infant’s
parent asks which vital sign changes are expected in a child experiencing pain. The
nurse’s best response is:
1. “We expect to see a child’s heart rate decrease and respiratory rate increase.”
2. “We expect to see a child’s heart rate and blood pressure decrease.”
3. “We expect to see a child’s heart rate and blood pressure increase.”
4. “We expect to see a child’s heart rate increase and blood pressure decrease.”
Toddlers
19. Which statement by the mother of an 18-month-old would lead the nurse to believe
that the child should be referred for further evaluation for developmental delay?
1. “My child is able to stand but is not yet taking steps independently.”
2. “My child has a vocabulary of approximately 15 words.”
3. “My child is still sucking his thumb.”
4. “My child seems to be quite wary of strangers.”
20. The mother of a child 2 years 6 months has arranged a play date with the neighbor
and her child 2 years 9 months. During the play date the two mothers should expect
that the children will do which of the following?
1. Share and trade their toys while playing.
2. Play with one another with little or no conflict.
3. Play alongside one another but not actively with one another.
4. Only play with one or two items, ignoring most of the other toys.
21. Which foods would the nurse recommend to the mother of a 2-year-old with
anemia?
1. 32 oz of whole cow’s milk per day.
2. Meats, eggs, and green vegetables.
3. Fruits, whole grains, and rice.
4. 8 oz of juice, three times per day.
22. A 2-year-old admitted to the hospital 2 days ago has been crying and is inconsolable
much of the time. The nurse’s best response to the child’s parents who are concerned
about this behavior is that the child is in the:
1. Detachment phase of separation anxiety, which is normal for children during
hospitalization.
2. Despair stage of separation anxiety, which is normal for children during hospitalization.
3. Bargaining stage of separation anxiety, which is normal for children during
hospitalization.
4. Protest stage of separation anxiety, which is normal for children during hospitalization.
23. Which should the nurse do to prevent separation anxiety in a hospitalized toddler?
1. Assume the parental role when parents are not able to be at the bedside.
2. Encourage the parents to always remain at the bedside.
3. Establish a routine similar to that of the child’s home.
4. Rotate nursing staff so the child becomes comfortable with a variety of nurses.
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24. According to developmental theories, which important event is essential to the
development of the toddler?
1. The child learns to feed self.
2. The child develops friendships.
3. The child learns to walk.
4. The child participates in being potty-trained.
25. Which comment should the parent of a 2-year-old expect from the toddler about a
new baby brother?
1. “When the baby takes a nap, will you play with me?”
2. “Can I play with the baby?”
3. “The baby is so cute. I love him.”
4. “It is time to put him away so we can play.”
26. Which stressor is common in hospitalized toddlers? Select all that apply.
1. Social isolation.
2. Interrupted routine.
3. Sleep disturbances.
4. Self-concept disturbances.
5. Fear of being hurt.
Preschooler
27. Which nursing action would help foster a hospitalized 3-year-old’s sense of
autonomy?
1. Let the child choose what time to take the oral antibiotics.
2. Allow the child to have a doll for medical play.
3. Allow the child to administer her own dose of Keflex (cephalexin) via oral syringe.
4. Let the child watch age-appropriate videos.
28. The best method to explain a procedure to a hospitalized preschool-age child is to:
1. Show the child a pamphlet with pictures showing the procedure.
2. Have the 5-year-old next door tell the 4-year-old about the experience.
3. Demonstrate the procedure on a doll.
4. Show the child a video of the procedure
29. A 3-year-old is hospitalized for an ASD repair. The parents have decided to go home
for a few hours to spend time with her siblings. The child asks when her mommy
and daddy will be back. The nurse’s best response is:
1. “Your mommy and daddy will be back after your nap.”
2. “Your mommy and daddy will be back at 6:00 p.m.”
3. “Your mommy and daddy will be back later this evening.”
4. “Your mommy and daddy will be back in 3 hours.”
30. Which approach should the nurse use to gather information from a child brought to
the ED for suspected child abuse?
1. Promise the child that her parents will not know what she tells the nurse.
2. Promise the child that she will not have to see the suspected abuser again.
3. Use correct anatomical terms to discuss body parts.
4. Tell the child that the abuse is not her fault and that she is a good person.
31. Which reaction would a nurse expect when giving a preschooler immunizations?
1. The child remains silent and still.
2. The child cries and tells the nurse that it hurts.
3. The child tries to stall the nurse.
4. The child remains still while telling the nurse that she is hurting him.
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32. What can a nurse do to reinforce a 5-year-old’s intellectual initiative when he asks
about his upcoming surgery?
1. Answer the child’s questions about his upcoming surgery in simple terms.
2. Provide the child with a book that has vivid illustrations about his surgery.
3. Tell the child he should wait and ask the doctor his questions.
4. Tell the child that she will answer his questions at a later time.
33. A 5-year-old boy has always been one of the shortest children in class. His mother
tells the school nurse that her husband is 6⬘ tall and she is 5⬘7⬙. What should the
nurse tell the child’s mother?
1. He is expected to grow about 3 inches every year from ages 6 to 9 years.
2. He is expected to grow about 2 inches every year from ages 6 to 9 years.
3. He should be seen by an endocrinologist for growth-hormone injections.
4. His growth should be re-evaluated when he is 7 years old.
34. The nurse realizes that a 5-year-old’s mother needs further education about the
Denver Developmental Screening Test when she states:
1. “It screens for gross motor skills.”
2. “It screens for fine motor skills.”
3. “It screens for intelligence level.”
4. “It screens for language development.”
35. A 3-year-old admitted to the hospital with croup has the following vital signs: heart
rate 90, respiratory rate 44, blood pressure 100/52, and temperature 98.8°F (37.1°C).
The parents ask the nurse if these vital signs are normal. The nurse’s best response is:
1. “Your son’s blood pressure is elevated, but the other vital signs are within the
normal range..”
2. “Your son’s temperature is elevated, but the other vital signs are within the normal
range..”
3. “Your son’s respiratory rate is elevated, but the other vital signs are within the
normal range.”
4. “Your son’s heart rate is elevated, but the other vital signs are within the normal
range.”
36. Which action is a developmentally appropriate method for eliciting a 4-year-old’s
cooperation in obtaining the blood pressure?
1. Have the child’s parents help put on the blood pressure cuff.
2. Tell the child that if he sits still, the blood pressure machine will go quickly.
3. Ask the child if he feels a squeezing of his arm.
4. Tell the child that measuring the blood pressure will not hurt.
37. A 4-year-old hospitalized with FTT has orders for daily weights, strict intake and
output, and calorie counts. Which action by the nurse would be a concern?
1. The nurse weighs the child every morning before breakfast.
2. The nurse weighs the child with no clothing except for undergarments.
3. The nurse sits with the child while the child eats her meals.
4. The nurse weighs the child using the same scale every morning.
38. A 3-year-old is attending her grandfather’s funeral. Her parents told her that her
grandfather is in heaven with God. Which statement describes a 3-year-old child’s
understanding of spirituality?
1. “The body is here with us on Earth, and the spirit is in heaven.”
2. “He is in heaven. Is this heaven?”
3. “The spirit is no longer in his body.”
4. “He won’t need his body in heaven.”
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39. A 3-year-old boy has been hospitalized because he fell down the stairs. His mother is
crying and states, “This is all my fault.” Which is the nurse’s best response?
1. “Accidents happen. You shouldn’t blame yourself.”
2. “Falls are one of the most common injuries in this age group.”
3. “It may be a good idea to put a baby gate on the stairs.”
4. “Your son should be proficient at walking down the stairs by now.”
School Age
40. Which nursing action is most appropriate to gain information about how a child is
feeling?
1. Actively attempt to make friends with the child before asking about her feelings.
2. Ask the child’s parents what feelings she has expressed in regard to her diagnosis.
3. Provide the child with some paper to draw a picture of how she is feeling.
4. Ask the child direct questions about how she is feeling.
41. Which statement would indicate to the nurse that a school-age child is not
developmentally on track for age?
1. The child is able to follow a four- to five-step command.
2. The child started wetting the bed on admission to the hospital.
3. The child has an imaginary friend named Kelly.
4. The child enjoys playing board games with her sister.
42. Which statement accurately describes how the nurse should approach an 11-year-old
to do a physical assessment?
1. Ask the child’s parents to remain in the room during the physical exam.
2. Auscultate the heart, lungs, and abdomen first.
3. Explain that the physical exam will not hurt.
4. Explain what the nurse will be doing in basic understandable terms.
43. Which is the best method of distraction for an 8-year-old who is having surgery later
today and is NPO?
1. Use the telephone to call friends.
2. Watch television.
3. Play a board game.
4. Read the central line pamphlet he was given.
44. Which activity can the nurse provide for a 9-year-old to encourage a sense of
industry?
1. Allow the child to choose what time to take his medication.
2. Provide the child with the homework his teacher has sent.
3. Allow the child to assist with his bath.
4. Allow the child to help with his dressing change.
45. The mother of 11-year-old fraternal twins tells the nurse at their well-child checkup
that she is concerned because her daughter has gained more weight and height than
her twin brother. The mother is concerned that there is something wrong with her
son. The nurse’s best response is:
1. “I understand your concern. I will talk with the physician, and we can draw some
lab work.”
2. “Let me ask you whether your son has been ill lately.”
3. “It is normal for girls to grow a little taller and gain more weight than boys at
this age.”
4. “It is normal for you to be concerned, but I am sure your son will catch up with
your daughter eventually.”
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46. A 9-year-old girl builds a clubhouse in her backyard. She hangs a sign outside
her clubhouse that says “No boys allowed” printed on it. The child’s parents are
concerned that she is excluding their neighbor’s son, and they are upset. What
should the school nurse tell the child’s parents?
1. Her behavior is cause for concern and should be addressed.
2. Her behavior is common among school-age children.
3. Her feelings about boys will subside within the next year.
4. They should have their daughter speak with the school counselor.
47. What information should a school nurse include in a discussion on nutrition with a
fourth-grade class?
1. The number of calories that a fourth-grade child should consume in a day.
2. A list of high-calorie foods that all fourth-graders should avoid.
3. How to read food labels so children know which foods are good for them.
4. A list of nutritious foods with basic scientific information about how they affect
the body organs and systems.
48. Which technique should the nurse suggest to the mother of an 8-year-old who does
not want to complete her chores?
1. Grounding.
2. Time-out.
3. Reward system.
4. Spanking.
49. Which should the nurse recommend to the parents of a 9-year-old hospitalized
following a bicycle injury? To prevent future injury, their child should:
1. Wear safety equipment while riding bicycles.
2. Read educational material on bicycle safety.
3. Watch a video on bicycle safety.
4. Ride his bike in the presence of adults.
Adolescent
50. A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for
2 weeks while he receives IV antibiotics. Which action taken by the nurse will most
enhance his psychosocial development?
1. Fax the teen’s teacher, and have her send in his homework.
2. Encourage the teen’s friends to visit him in the hospital.
3. Encourage the teen’s grandparents to visit frequently.
4. Tell the teen he is free to use his phone to call or text friends.
51. To obtain an adolescent’s health information, the nurse should:
1. Interview the adolescent using direct questions.
2. Gather information during a casual conversation.
3. Interview the adolescent only in the presence of the parents.
4. Gather information only from the parents.
52. Which method is the most effective way to present an educational program on
abstinence to adolescents?
1. Use peer-led programs that emphasize the consequences of unprotected sexual
contact.
2. Teach students methods to resist peer pressure.
3. Offer students the opportunity to care for a simulator infant for 1 week.
4. Offer statistics, pamphlets, and films discussing the consequences of unprotected
sexual contact.
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53. An 18-year-old with a rash and itching in the groin area is concerned that he has
contracted a sexually transmitted disease and does not want his parents to find out.
The nurse’s best response is:
1. “We will need to contact your parents to let them know.”
2. “We will not contact your parents regarding this visit.”
3. “Who would you like us to contact about your visit here today?”
4. “We cannot promise that the hospital will not contact your parents.”
54. A 13-year-old boy is hospitalized for a femur fracture. He was hit by a car while he
and his friends were racing bikes near a major intersection. The child’s parents are
concerned about his judgment. The nurse should tell the parents that the behavior is:
1. Typical of young teens.
2. Related to hormonal surges during adolescence.
3. An isolated incident and will not likely happen again.
4. Related to teen rebellion.
55. A 16-year-old is having a discussion with the nurse about the teen’s recent diagnosis
of lupus. In explaining the child’s prognosis, the nurse uses the knowledge that
adolescents are:
1. Preoccupied with thoughts of the here and now.
2. Able to understand and imagine possibilities for the future.
3. Capable of thinking only in concrete terms.
4. Overly concerned with past events and relationships.
56. The mother of a 13-year-old girl tells the nurse that she is concerned because her
daughter has gained 10 lb since she began puberty. The child’s mother asks the nurse
for advice about what to do about her daughter’s weight gain. Which should the
nurse do?
1. Provide the child’s mother with some pamphlets on nutrition and healthy eating.
2. Provide the child’s mother with information about a new exercise program for
teens.
3. Inform the child’s mother that it is common for teen girls to gain weight during
puberty.
4. Inform the child’s mother that her daughter will likely gain another 5 to 10 lb in
the next year.
57. A 13-year-old tells the nurse that he is worried because his breasts are growing. They
hurt, and he is embarrassed to take his shirt off during gym class. What should the
nurse tell him?
1. “The pediatrician will draw some blood to find out why your breasts are growing.”
2. “It is just a slight hormonal imbalance that can be easily corrected with medication.”
3. “This is a normal condition of puberty that will resolve within a year or two.”
4. “This is a rare finding that occurs in about 5% of boys during puberty.”
58. An adolescent has a diagnosis of new-onset diabetes. What would most influence a
teenager’s food choices as he begins to make changes in his diet?
1. Parents and their dietary choices.
2. Cultural background.
3. Peers and their dietary choices.
4. Television and other forms of media influence.
59. The mother of a 15-year-old is frustrated because he spends much of his weekend
time sleeping. Which is the nurse’s best response to the mother’s frustration?
1. “Your son may be trying to catch up on the sleep missed during the week.”
2. “Developmental theorists believe that teens require more sleep as they begin to
integrate new roles into their lives.”
3. “Teens require more sleep due to the rapid physical growth that is occurring.”
4. “Teens require more sleep due to the increase in their social obligations.”
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60. During an adolescent’s initial physical assessment, the nurse notes signs and symptoms of nutritional deficit. Which assessment led the nurse to this initial conclusion?
1. Protein level within normal limits.
2. Blood pressure is 110/66.
3. Hair and nails are brittle and dry.
4. Teeth appear to be eroded.
61. The mother of an adolescent complains that he has had some recent behavioral
changes. He comes home from school every day, closes his door, and refrains from
interaction with his family. The nurse’s best response to the mother is:
1. “You should speak with your son and ask him directly what is wrong with him.”
2. “You should set limits with your son and tell him that this is unacceptable behavior.”
3. “Your son’s behavior is abnormal, and he is going to need a psychiatric referral.”
4. “Your son’s behavior is normal. You should listen to him without being judgmental.”
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. At 6 months the weight should be approximately two times the birth weight.
2. Infants gain weight at their own pace but
should double the birth weight by 4 to
6 months.
3. Infants should double their birth weight
by 4 to 6 months of age.
4. By 6 months an infant should have doubled
the birth weight; 10 lb is a lot of weight to
gain in 4 to 6 months.
TEST-TAKING HINT: The test taker should
have learned this specific physical
developmental milestone.
2. 1. Having parents close to the child is important, but infants are most secure when they
are being held, patted, and talked to.
2. It is important that the nurse keep the parents
informed about their child’s condition, but it
does not have any impact on the child’s trustversus-mistrust relationship with the parents.
3. Having parents hold their child while in
the hospital is an excellent means of
building the trust relationship. Infants
are most secure when they are being
held, patted, and spoken to.
4. Parents should be encouraged to learn their
child’s care, but it is not the best means of
enhancing the trust relationship.
TEST-TAKING HINT: The test taker must
understand Erickson’s stages, including
the individual tasks that are met during
each stage.
3. 1. The deltoid of a 6-month-old is not developed enough and should not be used for IM
injections.
2. A nurse should not deliver more than
1 mL per IM injection to a 6-month-old.
3. The dorsogluteal muscle should not be used
in children until they have been walking for
at least 2 years.
4. The vastus lateralis is the site of choice for
an IM injection for a child 6 months old.
However, the injection should not be more
than 1 mL for a single injection.
TEST-TAKING HINT: The test taker must
have knowledge of IM injections sites
and acceptable volumes for children of
varying ages.
4. 1. Breastfeeding is the ideal nutrition for the
first year of life. Cereal can be introduced
between 4 and 6 months of age.
2. Infants should be started on vegetables
prior to fruits. The sweetness of fruits
may inhibit infants from taking vegetables.
3. It is essential to introduce new foods one at a
time to determine if a child has any allergies.
4. Infants can be given fruit juice by 6 months
of age, but it is recommended not to exceed
4 to 6 ounces per day.
TEST-TAKING HINT: The test taker must
have knowledge of the recommended
nutrition for an infant.
5. 1. Children 12 months old are best assessed in
proximity to their parents.
2. The appropriate sequence for assessment with
an infant is to auscultate first, palpate next,
and assess ears, eyes, and mouth last. Least
invasive procedures are recommended first.
3. Infants do not like to be held down. This
will likely cause the child distress. If the
child needs to be held down, it is best to
enlist the aid of another staff member.
4. Infants are most secure when in proximity to the parent. The parent’s lap is
an excellent place to assess the child.
TEST-TAKING HINT: Health-care professionals
must use developmentally appropriate
methods to approach children. The test
taker must have knowledge of a child’s psychosocial development. Answers 1 and 2 can
be eliminated because these methods of
assessment would be used on an older child.
6. 1. Breast milk or an iron-fortified formula is
recommended as the primary source of
nutrition for the first year of life.
2. Premature infants have iron stores from the
mother that last approximately 2 months, so
it is important to introduce an iron supplement by 2 months of age. .
3. Premature infants have iron stores
from the mother that last approximately
2 months, so it is important to introduce
an iron supplement by 2 months of age.
Full-term infants have iron stores that
last approximately 4 to 6 months.
4. Iron-fortified cereals are a good source of
iron once a child is old enough to consume
solid foods.
TEST-TAKING HINT: The test taker must
have knowledge of the recommended
nutrition for an infant.
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7. 1. A loss of a few ounces during the first
few days of life is normal. There will be a
reason for concern if the infant does not
gain weight within the next week.
2. Newborns can lose up to 10% of their
birth weight without concern but should
regain their birth weight by 2 weeks of age.
3. The nurse should not make this comment.
The mother will likely feel belittled, and she
may be afraid to ask questions in the future.
4. A loss of a few ounces during the first few
days of life is normal. Many times infants of
breastfeeding mothers lose weight initially because the mother’s milk has not come in yet.
TEST-TAKING HINT: The test taker can eliminate 3. This is a non-therapeutic response.
Remembering that newborns can lose up to
10% of their birth weight will help you
choose the right response.
8. 1. The child can play with a small baby doll,
but she will likely just put the doll in her
mouth. She is not old enough to play
appropriately with this toy.
2. A musical rattle is the perfect toy for
this child. Infants have short attention
spans and enjoy auditory and visual
stimulation.
3. Reading to children is essential throughout
childhood. However, the child will likely just
chew on the book, so it is not the ideal choice.
4. Beads are not appropriate for infants due to
the risk of choking.
TEST-TAKING HINT: The test taker must
understand the developmental level of the
child and know safety issues in order to
choose the appropriate toy.
with demonstration and return demonstration; therefore, the test taker can
eliminate answers 1 and 4.
10. 1. Babies born to mothers positive for hepatitis B receive the first dose of hepatitis B
vaccine within 12 hours of delivery.
2. The first dose of hepatitis B vaccine
is recommended between birth and
2 months. In most hospitals, newborns
are given the vaccine prior to
discharge.
3. The first dose of hepatitis B vaccine is
recommended between birth and 2 months.
In most hospitals, newborns are given the
vaccine prior to discharge.
4. The first dose of hepatitis B vaccine is
recommended between birth and 2 months.
In most hospitals, newborns are given the
vaccine prior to discharge.
TEST-TAKING HINT: The test taker must
have knowledge of vaccination schedules
for children of varying ages.
11. 1. The posterior fontanel should close
between 6 and 8 weeks of age.
2. The anterior fontanel usually closes
between 12 and 18 months.
3. The infant usually has a first tooth erupt
at about 6 months of age.
4. The infant should be able to track
objects.
TEST-TAKING HINT: This is a specific physical developmental milestone that should
be memorized.
9. 1. Pamphlets may be a useful tool to reinforce
teaching. However, a hands-on approach is
best in this situation.
2. The nurse could accompany the parents
if she is proficient in car-seat safety and
installation.
3. The car-seat safety officer is the best
choice, as that individual would have the
needed information and certification to
help the family.
4. A video may be a useful tool to reinforce
teaching. However, a hands-on approach is
best in this situation.
12. 1. It is possible for children to develop a
mild rash after receiving the varicella
vaccine. However, the varicella vaccine is
not usually administered prior to 1 year
of age.
2. The nurse should not give the vaccine.
The varicella vaccine is not usually
administered prior to 1 year of age.
3. The varicella vaccine is not usually
administered prior to 1 year of age.
4. The recommendation is that a second dose
be administered at 4 to 6 years of age.
TEST-TAKING HINT: The test taker must
understand basic immunization schedules
to answer the question.
TEST-TAKING HINT: The question requires
knowledge of the safety concerns involving proper car-seat installation. The question also requires the test taker to implement teaching and learning strategies for
educating parents. Most people learn best
13. 1. Poisoning is more common among toddlers
and preschoolers who are ambulating.
2. Child abuse is not one of the leading
causes of injury and death in children.
Accidents are the most common cause of
injury and death.
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3. Aspiration is a common cause of injury
and death among children of this age.
These children often find small objects
lying on the floor and place them in
their mouths. Older siblings are often
responsible for leaving small objects
around.
4. Dog bites are not a leading cause of injury
or death in children.
TEST-TAKING HINT: The test taker must
have knowledge of the primary safety
concerns of infants. Answer 1 can be
eliminated, as poisoning is more common
among preschoolers. Child abuse and dog
bites, answers 2 and 4, are not common
causes of injury and death in infants.
14. 1. A normal systolic blood pressure for a
child from birth to 1 month is 50 to 101.
A normal diastolic blood pressure for a
child from birth to 1 month is 42 to 64.
2. A normal temperature is 96.6°F to 100°F
(35.8°C to 37.7°C).
3. A normal respiratory rate for a child from
birth to 1 month is 30 to 60.
4. A normal heart rate for a child from
birth to 1 month is 90 to 160.
TEST-TAKING HINT: Normal vital signs for
each age group should be memorized in
order to understand abnormalities that
occur with different disease processes.
15. 1. It is always a good idea for parents to
administer medications at the same time
each day.
2. Medications should never be mixed in
a large amount of food or formula
because the parent cannot be sure that
the child will take the entire feeding.
Formula decreases the absorption
of iron.
3. Giving medications in a nipple is an
acceptable method of administering liquid
oral medications to infants.
4. An oral syringe is a good method of
administering oral medications. The
syringe should be placed in the back
side of the cheek. Small amounts of the
medication should be given at a time.
TEST-TAKING HINT: The test taker must
have knowledge of medication administration. Answers 1, 3, and 4 can be eliminated
as they are all appropriate methods for
administering medications to infants.
16. 1. Vital signs are not considered when measuring pain using the FLACC scale.
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DEVELOPMENT
2. The parents’ perception of their child’s
pain level is not considered when using
the FLACC scale.
3. The FLACC scale utilizes behavioral
and physical responses of the child to
measure the child’s level of pain. The
scale utilizes facial expression, leg
position, activity, intensity of cry, and
level of consolability.
4. The FLACC scale assigns a numeric value
to a child’s pain level, which is rated from
0 to 10.
TEST-TAKING HINT: The test taker must
have knowledge of pain rating scales used
to measure the pain of nonverbal children.
17. 1. Children should double their birth weight
by 6 months of age.
2. Children should triple their birth weight
by 12 months of age.
3. Children should triple their birth
weight by 12 months of age.
4. Children should triple their birth weight
by 12 months of age.
TEST-TAKING HINT: This is a specific physical developmental milestone that should
be memorized.
18. 1. When a child is experiencing pain, the
normal physiological response is for the
heart rate and respiratory rate to increase.
2. When a child is experiencing pain, the
normal physiological response is for the
heart rate and blood pressure to increase.
3. When a child is experiencing pain, the
normal physiological response is for
the heart rate, respiratory rate, and
blood pressure to increase.
4. When a child is experiencing pain, the
normal physiological response is for the
heart rate, respiratory rate, and blood
pressure to increase.
TEST-TAKING HINT: The test taker must
have knowledge of vital sign changes that
occur when a child is in pain.
19. 1. The child should be walking independently by 15 to 18 months. Because this
toddler is 18 months and not walking, a
referral should be made for a developmental consult.
2. The vocabulary of an 18-month-old
should be 10 words or more.
3. Thumb-sucking is still common for
18-month-olds and may actually be at its
peak at that age.
4. It is very common for a child of 18 months
to exhibit stranger anxiety.
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TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker needs to know basic developmental milestones in order to choose the
appropriate intervention.
20. 1. Toddlers do not share their possessions
well. One of their favorite words is
“mine.”
2. Because toddlers do not share well, they
are often in conflict with one another
during play.
3. Toddlers engage in parallel play. They
often play alongside another child, but
they rarely engage in activities with the
other child.
4. Toddlers have very short attention spans
and commonly play with various items for
short periods.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker needs to know the developmental level of the child in order to choose
the appropriate form of play.
21. 1. One of the primary reasons toddlers develop anemia is because they are consuming too much milk, which is limiting their
intake of iron-rich foods. Milk is a poor
source of iron and should be limited to
24 ounces per day.
2. Meat, eggs, and green vegetables are
excellent sources of iron.
3. Iron-enriched cereals are a good choice
for children, but this list of foods does not
contain the most iron-rich foods.
4. Increasing the amount of juice the child
consumes is not the focus. Instead, the
focus is on providing the child with the
most iron-rich foods.
TEST-TAKING HINT: The test taker must
have knowledge of the recommended
nutrition for children and which foods
are high in iron such as eggs, meats, and
fortified cereals.
22. 1. During the detachment phase of separation anxiety, children are usually fairly
cheerful, and they often lack a preference
for their parents.
2. During the despair stage of separation
anxiety, children usually have a loss of
appetite, altered sleep patterns, and a lack
of much interest in play.
3. The bargaining stage is not a stage of
separation anxiety; it is one of the stages
of grief.
4. During the protest stage of separation
anxiety, children are often inconsolable, and often cry more than they
do when they are at home. These
children also frequently ask to go
home.
TEST-TAKING HINT: The test taker must
know the stages of separation anxiety to
answer the question.
23. 1. The nurse should try to comfort the child
and be friendly, but should not try to
replace the parent.
2. Parents should be encouraged to be with
their child as much as possible. However,
parents may feel guilty if they leave knowing the staff believes the parents should
always be at the bedside.
3. It is very important to try to maintain
a child’s home routine both when parents are present and when they have to
leave the hospital. This will increase
the child’s sense of security and
decrease anxiety.
4. Providing consistent nursing care is important, not rotating staff. The child needs
consistent care to decrease anxiety.
TEST-TAKING HINT: The test taker must
have knowledge of the stages of separation
anxiety. Answer 1 can be ruled out because
the nurse should never assume a parental
role with a child. Answer 4 can be eliminated because it is essential that children
be provided with continuity of care.
24. 1. Toddlers are in a stage of life in which
they like to do for themselves. However,
developmental theorists like Erickson and
Freud believe that toilet training is the
essential event that must be mastered by
the toddler.
2. Toddlers engage in more parallel play.
Building friendships is not common until
school age and adolescence.
3. Walking should be mastered by 18 months
of age.
4. Developmental theorists like Erickson
and Freud believe that toilet training
is the essential event that must be
mastered by the toddler.
TEST-TAKING HINT: The test taker must be
able to apply the developmental theories
of Freud and Erickson.
25. 1. Toddlers are egocentric and are not yet
capable of delayed gratification. It is
unlikely that the child will wait to play
with her parent until the baby sleeps.
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2. Toddlers do not usually engage in play
with others. They are generally involved
in parallel play.
3. Toddlers usually initially resent the
presence of new siblings because they
take away some of the parents’ time and
attention.
4. This is a typical statement that would
be made by a toddler. Toddlers are
very egocentric and do not consider
the needs of the other child.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must know the psychosocial
development of the toddler in order to
choose the appropriate statement.
26.
2, 3, 5.
1. Social isolation is a stressor of the hospitalized teen.
2. Common stressors of the hospitalized
toddler include interrupted routine,
sleep pattern disturbances, and fear of
being hurt.
3. Common stressors of the hospitalized
toddler include interrupted routine,
sleep pattern disturbances, and fear of
being hurt.
4. Self-concept disturbance is a stressor of
the hospitalized teen.
5. Common stressors of the hospitalized
toddler include interrupted routine,
sleep pattern disturbances, and fear of
being hurt.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must know the developmental
level of the child and common stressors
that affect hospitalization to choose the
appropriate intervention.
27. 1. Medication administration times must be
adhered to. A preschooler should not be
allowed to choose administration times.
2. A doll for medical play is an excellent
method for teaching children about medical procedures, but it will not enhance
her sense of autonomy.
3. Allowing preschoolers to participate
in actions of which they are capable is
an excellent way to enhance their
autonomy.
4. Age-appropriate videos are a good way to
occupy the child during hospitalization,
but they will not enhance her autonomy.
TEST-TAKING HINT: The test taker must
understand the meaning of the word
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DEVELOPMENT
“autonomy” and know Erickson’s stages
of development to answer this question.
The test taker also needs to consider safe
nursing care. Answer 1 could be detrimental to the welfare of the child.
28. 1. The child is too young to understand the
procedure using pamphlets.
2. Four-year-old children are egocentric and
will not relate other children’s experience
to their own.
3. A 4-year-old child understands in very
concrete and simple terms. Therefore,
medical play is an excellent method for
helping to understand the procedure.
4. The nurse has no idea how long the procedure will take and should not give the
child information that may not be reliable.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand the developmental level of the child to choose the
appropriate intervention. Most 4-yearolds are unable to read, so choice 1 can
be eliminated.
29. 1. Preschoolers understand time in
relation to events.
2. Preschoolers cannot tell time.
3. Preschoolers want concrete information,
and the words “this evening” are not
meaningful to them.
4. Preschoolers have no concept how long an
hour is.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must have knowledge of a child’s
understanding of the concept of time.
Answers 2, 3, and 4 can be eliminated
because they provide choices for time
measurement that would only be understandable to children school-age or older.
30. 1. The nurse should always be honest with
the child to develop a level of trust. The
nurse should not promise not to tell.
2. The nurse should not make a promise that
cannot be kept. Once again, the trust
relationship could be jeopardized if the
child feels the nurse lied.
3. The nurse should discuss body parts in
relation to the child’s vocabulary.
4. Many young children believe abuse or
illness is their fault, and they should be
reminded they are not to blame. Many
children this age believe they have
acquired a disease or have been abused
because they are bad people.
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TEST-TAKING HINT: The safety and security
of the child is paramount. The child needs
to know she is safe and she did not cause
the abuse. Answers 1 and 2 can be eliminated because of the word “promise.” The
nurse needs to build a trusting relationship with the child and should never make
a promise that cannot be kept.
31. 1. Teens are more likely to be stoic and
remain still and silent during injections.
2. The common response of a 5-year-old
is to cry and protest during an immunization.
3. School-age children are most likely to try
to stall the nurse.
4. Teens usually remain still, and they may
calmly tell the nurse that they are feeling
pain during the injection.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand the child’s
psychosocial development in order to
choose the appropriate response.
32. 1. The child is taking the initiative to ask
questions, as all preschoolers do,
and the nurse should always answer
those questions as appropriately
and accurately as possible.
2. A book illustrating what will happen to
the child may help him, but it will not
encourage his intellectual initiative.
3. By not answering the child’s questions, the
nurse may actually be stifling his sense of
initiative.
4. By not answering the child’s questions, the
nurse may actually be stifling his sense of
initiative.
TEST-TAKING HINT: The test taker must
understand the cognitive level of the child
in order to choose the appropriate intervention. Answers 3 and 4 can be eliminated because the nurse is avoiding the
child’s questions.
33. 1. During the school-age years, a child grows
approximately 2 inches per year.
2. During the school-age years, a child
grows approximately 2 inches per year.
3. This is not the appropriate time to have
the child evaluated. His mother needs to
reserve her concerns until he is older. He
will likely begin to catch up with his peers
within the next year.
4. The child should continue to see his
pediatrician for annual visits, but there is
no need for a special visit to re-evaluate
his growth at this time.
TEST-TAKING HINT: This is a specific physical developmental milestone that should
be memorized.
34. 1. The Denver Developmental Test evaluates
children from 1 month to 6 years and is
used to screen gross motor skills, fine
motor skills, language development, and
personal/social development.
2. The Denver Developmental Test evaluates
children from 1 month to 6 years and is
used to screen gross motor skills, fine
motor skills, language development, and
personal/social development
3. The Denver Developmental Test does
not test a child’s level of intelligence.
4. The Denver Developmental Test evaluates
children from 1 month to 6 years and is
used to screen gross motor skills, fine
motor skills, language development, and
personal/social development.
TEST-TAKING HINT: The test taker must
know the Denver Developmental Test and
what it screens for.
35. 1. A normal systolic blood pressure for a
child from 3 to 6 years is 78 to 111. A
normal diastolic blood pressure for a child
from 3 to 6 years is 42 to 70.
2. A normal temperature is 96.6°F to 100°F
(35.8°C to 37.7°C).
3. A normal respiratory rate for a child
from 3 to 6 years is 20 to 30 breaths
per minute.
4. A normal heart rate for a child from 3 to
6 years is 75 to 120.
TEST-TAKING HINT: Normal vital signs for
each age group should be memorized in
order to understand abnormalities that
occur with different disease processes.
36. 1. Preschool children like to do things for
themselves and will not likely behave any
better for the parents than the nurse.
2. The nurse should not promise the child
that the procedure will go quickly. The
nurse needs to develop a trusting relationship with the child; therefore, only promises that can be kept should be made.
3. Preschool children enjoy games, and it
is a good way to elicit their assistance
and cooperation during a procedure.
4. The nurse should not promise the child
that the procedure will not hurt. Each
child’s perception of pain is individual.
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The nurse needs to develop a trusting
relationship with the child; therefore, only
promises that can be kept should be made.
TEST-TAKING HINT: The test taker needs to
understand the psychosocial and cognitive
development of a preschooler in order to
choose the appropriate intervention. Answers 2 and 4 can be eliminated because
nurses should never make promises to
children that they may not be able to
keep. It is difficult to build a trusting
relationship with children unless the
nurse is completely honest.
37. 1. The child should be weighed every
day on the same scale before eating.
Her weight will not be an accurate
reflection if she is fed prior to being
weighed.
2. The child should be weighed only in
undergarments. The weight of clothing
must not be included.
3. The nurse should remain in the room
while the child eats in order to accurately
record a calorie count.
4. The child should be weighed on the same
scale every time. All scales are not equally
accurate, so it is important to use the same
scale in order to obtain an accurate trend.
TEST-TAKING HINT: The test taker must
have knowledge of a child’s nutrition and
how to obtain an accurate weight.
38. 1. Three-year-old children do not understand the difference between body and
spirit. Their understanding of spirituality
is literal in nature.
2. Three-year-old children are literal
thinkers. The child’s parents told her
that Grandpa was in heaven. She sees
his body, so she thinks they are all in
heaven.
3. Three-year-old children do not understand the difference between body and
spirit. Their understanding of spirituality
is literal in nature.
4. Three-year-old children think of spirituality in literal terms and do not understand
the concept of heaven.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand the cognitive
development of the child in order to
choose the appropriate response. Answers
1, 3, and 4 can be eliminated because they
demonstrate the understanding of an
older, school-age child.
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DEVELOPMENT
39. 1. This comment will not make the mother
feel any better. The mother is going to
blame herself regardless of where the blame
lies. The nurse would do better to just listen
than to make this sort of comment.
2. Falls are one of the most common
injuries, and it may make the parent
feel better to know that this is
common.
3. It may be a good idea to put up a baby
gate, but in this situation the nurse’s comment may be interpreted as judgmental.
4. Children walk, climb stairs, and run without paying attention to what might be in
their way and can fall easily.
TEST-TAKING HINT: The test taker must
understand the psychological state of the
parent. Most parents blame themselves
whenever their children are injured, so
answer 1 can be eliminated. Answer 3
implies that the injury is the parent’s
fault, so it too can be eliminated.
40. 1. The nurse should not attempt to make
friends with the child too quickly. The
child should be given the opportunity to
observe the nurse working in order to
increase her comfort level with the nurse.
2. The child’s parents are a good source of
information, but the child may not have
expressed all of her feelings to her parents.
3. Often children will include much more
detail about their feelings in drawings.
They will often express things in pictures they are unable to verbalize.
4. School-age children do not often share
all of their feelings verbally, especially to
people with whom they are not familiar.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must also have knowledge of
the psychosocial development of the
school-age child.
41. 1. School-age children should be able to
follow a four- to five-step command, so
this does not indicate that the child has a
developmental delay.
2. The child was potty-trained before entering the hospital, and it is important to
inform her mother that bedwetting is a
common form of regression seen in
hospitalized children. The child will likely
return to her normal toileting habits
when she returns home.
3. Most school-age children do not have
imaginary friends. This is much more
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common for children of 3 and 4 years
of age.
4. Most school-age children do enjoy playing
board games.
TEST-TAKING HINT: The test taker must
understand the stressors that affect
school-age children who are hospitalized
and how they react to those stressors
based on their developmental level.
42. 1. Privacy is very important to school-age
children. The child should be given the
choice whether his parents are present for
the exam.
2. School-age children can be assessed in a
head-to-toe sequence.
3. The nurse should not promise that the
exam will not hurt.
4. School-age children are capable of understanding basic functions of the body
and can understand what the nurse will
be doing if explained in basic terms.
TEST-TAKING HINT: Health-care professionals must approach children using
developmentally appropriate methods.
The test taker must have knowledge of a
child’s psychosocial development. Answers
1 and 2 can be eliminated because they
are methods of assessment used for
younger children.
43. 1. Talking to friends may distract the child
for some time. However, the conversation
could revert to a discussion about the upcoming surgery.
2. Watching television may distract the child
for some time, but he may still be thinking
about his surgery.
3. A board game is the optimal choice because school-age children enjoy being
engaged in an activity with others that
will require some skill and challenge.
4. Reading material about the surgery
will only increase his thoughts about the
surgery.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must utilize the cognitive developmental level of the child to choose the
appropriate method of distraction.
44. 1. Giving the child choices while in the hospital is important. However, medications
should be kept on schedule. It is essential
to give them at the prescribed time.
2. The school-age child is focused on
academic performance; therefore, the
child can achieve a sense of industry by
completing his homework and staying
on track with his classmates.
3. The child should have already mastered
bathing. It is not likely to give him a sense
of accomplishment.
4. The child may enjoy assisting with his
dressing change, but it is not the best example of industry.
TEST-TAKING HINT: The test taker must
have knowledge of Erickson’s stages of
development. Answer 1 can be eliminated
because it could be detrimental to children
to allow them to choose medication times.
Answers 3 and 4 can be eliminated because
they are not activities that help the child
achieve a sense of industry.
45. 1. This is not an appropriate response. The
nurse should be aware that it is normal
for girls to grow taller and gain more
weight than boys near the end of middle
childhood.
2. This is not an appropriate response. The
nurse should be aware that it is normal
for girls to grow taller and gain more
weight than boys near the end of middle
childhood.
3. This is the appropriate response. The
nurse understands that it is normal for
girls to grow taller and gain more
weight than boys near the end of
middle childhood.
4. This is not the best response. The boy will
likely surpass his sister when he reaches
adolescence.
TEST-TAKING HINT: This is a specific physical developmental milestone that should
be memorized.
46. 1. The child’s behavior is normal. Girls of
9 and 10 generally prefer to have friends
who are of the same gender.
2. This is common behavior. Girls of 9 and
10 generally prefer to have friends who
are of the same gender.
3. Girls of 9 and 10 generally prefer to have
friends who are of the same gender. The
child will likely have the same feelings
next year.
4. There is no need for the child to see the
counselor. Girls of 9 and 10 generally prefer
to have friends who are of the same gender.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker understands the psychosocial
development of the child in order to
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choose the appropriate behavior. Answer
3 can be eliminated because it is too
absolute. There is no way to determine
exactly how long the child will have these
feelings about boys.
47. 1. School-age children do not engage in
calorie counting. This is an adult activity.
2. Children may not want to hear this information, as most of them enjoy consuming
high-calorie foods that taste good.
3. School-age children do not engage in
calorie counting. This is an adult activity.
4. Reviewing nutritious choices keeps
the lesson on a positive note, and
school-age children are very interested
in how food affects their bodies. They
are capable of understanding basic
medical terminology.
TEST-TAKING HINT: The test taker must
have knowledge of the school-age children’s cognitive level and their ability to
process and understand information.
48. 1. Grounding is a technique that generally
works well with adolescents.
2. Time-out is a technique that is primarily
used for toddler and preschool children.
3. School-age children usually respond
very well to a reward system and often
enjoy the rewards so much that they
will continue chores without continual
reminders.
4. Spanking is never a suggestion that should
be given to families.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand the psychosocial development of the child in order to
choose the appropriate intervention. Answer 4 can be eliminated because physical
punishment should never be suggested.
Answer 1 can be eliminated because it is a
technique that works best with adolescents. Answer 2 can be eliminated because
it is a technique that works best with
toddlers and preschool children.
49. 1. Safety equipment is essential for bicycling, skateboarding, and participating
in contact sports. Most injuries occur
during the school-age years, when
children are more active and participate
in contact sports.
2. Educational material is a good way to
reinforce the use of safety equipment, but
the parents must insist that the child use
his safety equipment.
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DEVELOPMENT
3. Video material is a good way to reinforce
the use of safety equipment, but the
parents must insist that the child use his
safety equipment.
4. The child’s parents may not always be
present when he rides his bike, so the
use of safety equipment is the primary
concern.
TEST-TAKING HINT: This is a question
focusing on safety. The test taker must
understand that educational material may
reinforce a child’s knowledge of safety.
However, in order to avoid injury, the
best thing a parent can do is insist on the
use of safety equipment.
50. 1. The teen may want to continue his
schoolwork while in the hospital, but it
is not the best means of enhancing his
psychosocial development.
2. Teens are most concerned about
being like their peers. Having the
teen’s friends visit will help him feel
he is still part of the school and social
environment.
3. The teen may want to see his grandparents, but they are not the primary focus in
his life.
4. Calling or texting friends is a good means
of remaining in contact with peers. However, having direct contact with friends is
a better means of maintaining social
contact.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand that peers are
central to an adolescent’s life.
51. 1. Teens may not speak as freely when asked
direct questions.
2. Frequently adolescents will share more
information when it is gathered during
a casual conversation.
3. Teens may share more information when
they are not in the presence of their parents. It is important to interview the child
first. Parent information can be obtained
following the interview with the child.
4. It is important to gather information from
both the teen and the parent.
TEST-TAKING HINT: The age of the child is
essential to answering this question.
Answers 3 and 4 contain the word “only.”
There are rare instances in nursing when
the word “only” would apply. These
answers can usually be eliminated.
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52. 1. Adolescents are most concerned with
what their peers think and feel. They
are most receptive to information that
comes from another adolescent.
2. It is very difficult for teens to resist peer
pressure even with the appropriate tools of
resistance.
3. Infant simulators are useful, but they are
very expensive and often difficult to obtain.
4. Pamphlets are helpful aids in relaying
information to teens, but hearing the
information firsthand from a peer is the
most effective method of education.
TEST-TAKING HINT: The test taker must
understand the psychosocial development
of an adolescent in order to choose the
appropriate intervention. Adolescents
focus on their relationships with peers
and are much more influenced by peers
than by multimedia information or by
information provided by an adult.
53. 1. An adolescent has a right to privacy; if he
does not want his parents contacted, as
long as no harm has come to him they
do not need to be contacted.
2. An adolescent has every right to
privacy as long as the situation is not
life threatening.
3. The nurse can ask if the patient would like
the nurse to contact someone; again, if the
teen says no, that is his or her right.
4. An adolescent has every right to privacy as
long as the situation is not life threatening. Therefore, the hospital can promise
not to contact the parents.
TEST-TAKING HINT: The test taker must
have knowledge of the psychosocial
development of an adolescent and what
the state law says about privacy.
54. 1. The brains of young teens are not
completely developed, which often
leads to poor judgment and impulse
control.
2. Hormonal changes in teens play a primary
role in the development of secondary sex
characteristics.
3. The child may be prone to other lapses in
judgment. The brains of young teens are
not completely developed, which often
leads to poor judgment and low impulse
control.
4. The child’s behavior had nothing to do
with rebellion.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand the psychosocial and cognitive development of the
adolescent in order to choose the
appropriate intervention.
55. 1. Adolescents are becoming abstract
thinkers and are able to imagine possibilities for the future.
2. Adolescents are becoming abstract
thinkers and are able to imagine
possibilities for the future.
3. Preschool and school-age children think
in concrete terms. Adolescents are beginning to think in abstract terms.
4. Adolescents are becoming abstract thinkers
and are able to imagine possibilities for the
future. They are not preoccupied with past
events.
TEST-TAKING HINT: The test taker must
understand the cognitive level of an
adolescent in order to choose the
appropriate answer.
56. 1. The child’s mother may be interested in
information relating to proper nutrition
and exercise. However, the most important thing is for the nurse to let the child’s
mother know that this is a normal finding
in teenage girls as they enter puberty.
2. The child’s mother may be interested in
information relating to proper nutrition
and exercise. However, the most important thing is for the nurse to let the
mother know that this is a normal finding
in teenage girls as they enter puberty.
3. The nurse should tell the child’s
mother that this is a normal finding in
teenage girls as they enter puberty.
4. The nurse knows that it is normal for girls
to gain weight during puberty but has no
idea how much weight the child will gain
or if she will gain any more.
TEST-TAKING HINT: The test taker must
have knowledge of the physical development of adolescent girls.
57. 1. Gynecomastia and breast tenderness are
common for about a third of boys during
middle puberty. Gynecomastia usually
resolves in 2 years.
2. Gynecomastia and breast tenderness are
common for about a third of boys during
middle puberty. Gynecomastia usually
resolves in 2 years.
3. Gynecomastia and breast tenderness
are common for about a third of boys
during middle puberty. Gynecomastia
usually resolves in 2 years.
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4. Gynecomastia and breast tenderness are
common for about a third of boys during
middle puberty. Gynecomastia usually
resolves in 2 years.
TEST-TAKING HINT: The test taker must
have knowledge about the physical
development of adolescent boys.
58. 1. The child’s family does have some influence on his dietary choices, but teens are
more focused on being like their peers.
2. The child’s culture does affect his food
choices. However, teens are more likely to
choose “junk foods” and foods that their
peers are eating.
3. As a teen, the child is most influenced
by his peers. Teens long to be like
others around them.
4. Television does affect personal food
choices, but the peer group still has the
most prevalent impact in a teen’s life.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand that peers are
central to an adolescent’s life.
59. 1. Teens require more sleep due to the rapid
physical growth that occurs during
adolescence.
2. Teens are trying to integrate new roles
into their lives. However, that has no
impact on their need for increased sleep.
3. Teens require more sleep due to the
rapid physical growth that occurs
during adolescence.
4. Teens are generally more social and
may be staying out late. However, their
increased requirement for sleep is related
to their rapid growth during adolescence.
TEST-TAKING HINT: The test taker must
have knowledge of the physical growth
and development of adolescents.
60. 1. A low protein level could indicate a nutritional deficit. However, this would not be
an indication that the nurse sees on an
initial assessment. Lab work would be
required to have this information.
2. This is a normal blood pressure for a teen.
AND
DEVELOPMENT
3. Dry and brittle hair and nails are
common among people who have a
nutritional deficit.
4. Eroded teeth are common in those who
have frequent vomiting. The acidic nature
of the vomitus causes the enamel of the
teeth to deteriorate, causing erosion.
Eroded teeth may be seen in teens with
bulimia; however, by itself, this is not a
sign of nutritional deficit.
TEST-TAKING HINT: The test taker must
have knowledge of the nutritional needs
of an adolescent. Answer 1 can be eliminated because it states that the value is
normal. Answer 2 can be eliminated
because it is a normal blood pressure.
Answer 4 can be eliminated because it
relates more to bulimia than to nutritional
deficit alone.
61. 1. If the child’s parents confront him, he may
feel as though they are being judgmental,
and he will likely not want to communicate with them. When parents begin a dialogue with their child early on in life, they
are more capable of approaching the child
when they do notice behavioral changes.
2. Setting limits is always a good thing to do
with children. However, the child’s parents
are not addressing the reason for his
behavioral changes.
3. The child’s behavior is typical of a teen’s
response to developmental and psychosocial changes of adolescence. He does not
need a psychological referral at this time.
4. The child’s behavior is typical of a
teen’s response to developmental and
psychosocial changes of adolescence.
TEST-TAKING HINT: The age of the child is
essential to answering this question. The
test taker must understand the psychosocial development of an adolescent in
order to choose the appropriate answer.
Adolescents focus on their relationships
with peers and are much more influenced
by peers than by parents. Adolescents also
want privacy, so the best thing parents can
do is listen to their teens.
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3
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
100% Oxygen via non-rebreather mask
Activated charcoal
Alcohol poisoning
Anticipatory guidance
Assessment
Bacterial meningitis
Carbon monoxide poisoning
Cervical spine precautions
Child abuse
Childproofing measures
Concussion
Congenital hypothyroidism
Contact precautions
Cystic fibrosis
Digoxin
Droplet (airborne) precautions
Early intervention services
Epinephrine 1:1000 subcutaneous
injection
Erythema infectiosum (fifth disease)
Exanthema subitum (roseola)
Galactosemia
Genetic counseling
Hepatitis B antigen
Hepatitis B immune globulin
Hepatitis B vaccine
Immunizations
Initial neurological assessment
Jaw thrust maneuver
Kawasaki disease
Lead poisoning
Low-phenylalanine diet
Maple syrup urine disease
Munchausen syndrome by proxy
Near-drowning
Newborn assessment
Normal growth and development
Poisonings
Renal diet
Respiratory precautions
Rheumatic fever
Rotovirus vaccine
Serial neurological assessments
Sexual abuse
Shaken baby syndrome
Spinal cord injuries
Tay-Sachs disease
Tuberculosis
Vaccine information statement
Varicella (chickenpox)
Varicella vaccine
ABBREVIATIONS
Diphtheria, tetanus toxoid, and acellular
pertussis (DTaP)
Haemophilus influenza type B (Hib)
Human immunodeficiency virus (HIV)
Inactivated polio vaccine (IPV)
Measles, mumps, rubella (MMR)
Phenylketonuria (PKU)
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QUESTIONS
1. The mother of a 3-week-old tells the nurse she is residing in a homeless shelter and
is concerned about his mild cough, poor appetite, low-grade fever, weight loss, and
fussiness over the last 2 weeks. Which nursing intervention would be the nurse’s
highest priority?
1. Weigh the baby to have an accurate weight using standard precautions.
2. Reassure the mother that the baby may only have a cold, which can last a few
weeks.
3. Immediately initiate droplet face-mask precautions, and isolate the infant.
4. Take a rectal temperature while completing the assessment using standard
precautions.
2. Which would be the priority nursing intervention for a newly admitted child with
Kawasaki disease?
1. Continuous cardiovascular and oxygen-saturation monitoring.
2. Vital signs every 4 hours until stable.
3. Strict intake and output monitoring hourly.
4. Begin aspirin therapy after fever has resolved.
3. Which clinical assessment of a neonate with bacterial meningitis would warrant
immediate intervention?
1. Irritability.
2. Rectal temperature of 100.6°F (38.1°C).
3. Quieter than usual.
4. Respiratory rate of 24 breaths per minute.
4. An 18-month-old is discharged from the hospital after having a febrile seizure
secondary to exanthem subitum (roseola). On discharge, the mother asks the nurse if
her 6-year-old twins will get sick. Which teaching about the transmission of roseola
would be most accurate?
1. The child should be isolated in the home until the vesicles have dried.
2. The child does not need to be isolated from the older siblings.
3. Administer acetaminophen to the older siblings to prevent seizures.
4. Monitor older children for seizure development.
5. The mother of a child diagnosed with erythema infectiosum (fifth disease). is crying,
and says, “I am afraid. Will my unborn baby die? I have a planned cesarean section
next week.” Which statement would be the most therapeutic response?
1. “Let me get the physician to come and talk with you.”
2. “I understand. I would be afraid, too.”
3. “Would you like me to call your obstetrician to have you seen as soon as
possible?”
4. “I understand you are afraid. Can we can talk about your concerns?”
6. Which would be the priority intervention for a child suspected of having varicella
(chickenpox)?
1. Contact precautions.
2. Contact and droplet respiratory precautions.
3. Droplet respiratory precautions.
4. Universal precautions and standard precautions.
7. Which would be the priority intervention for a child diagnosed with chickenpox
(varicella) who was prescribed diphenhydramine (Benadryl) for itching?
1. Give a warm bath with mild soap before lotion application.
2. Avoid Caladryl lotion while taking diphenhydramine (Benadryl).
3. Apply Caladryl lotion generously to decrease itching.
4. Give a cool shower with mild soap to decrease itching.
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8. Which signs and symptoms would the nurse expect to assess in a child with
rheumatic fever?
1. Ankle and knee joint pain.
2. Negative group A beta streptococcal culture.
3. Large red “bulls eye”–appearing rash.
4. Stiff neck with photophobia.
9. The parents of a 12-month-old with HIV are concerned about his receiving routine
immunizations. What will the nurse tell them about immunizations?
1. “Your child will not receive routine immunizations today.”
2. “Your child will receive the recommended vaccines today
3. “Your child is not severely immunocompromised, but I would still be concerned
about his receiving them.”
4. “Your child may develop infections if he gets his routine immunizations. Your
child will not be immunized today.”
10. After airway, breathing, and circulation have been assessed and stabilized, which
intervention should the nurse implement for a child diagnosed with encephalitis?
1. Assist with a lumbar puncture, and give reassurance.
2. Obtain a throat culture, then begin antibiotics.
3. Perform initial and serial neurological assessments.
4. Administer antibiotics and antipyretics.
11. Expected nursing assessments of a newborn with suspected cystic fibrosis would
include:
1. Observe frequency and nature of stools.
2. Provide chest physical therapy.
3. Observe for weight gain.
4. Assess parent’s compliance with fluid restrictions.
12. Which treatment would the nurse anticipate for a 2-week-old boy diagnosed
with PKU?
1. There is no treatment or special diet.
2. A high-phenylalanine diet.
3. A low-phenylalanine diet.
4. The mother would be advised not to breastfeed the infant.
13. Which teaching would be important to discuss with the family of a newborn
with PKU?
1. Studies have shown that children with PKU outgrow the disease.
2. Consumption of decreased amounts of protein and dairy products is advised.
3. High-protein and high-dairy products consumption must be maintained.
4. Exclusive breastfeeding is encouraged for maximal nutrition for the child.
14. Which teaching is most important for a child with PKU?
1. The child is able to eat a quarter-pound hamburger and drink a milkshake daily.
2. If the child wants soda, diet soda is preferred over milk or dairy products.
3. The child may have ice cream in an unlimited quantity once a week.
4. Diet soda or anything with the sweetener aspartame should be avoided.
15. Which intervention should the nurse implement for a newborn diagnosed with
galactosemia?
1. Eliminate all milk and lactose-containing foods.
2. Encourage breastfeeding as long as possible.
3. Encourage lactose-containing formulas.
4. Avoid feeding soy-protein formula to the newborn.
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16. Which statement by the parent of a newborn diagnosed with galactosemia
demonstrates successful teaching?
1. “This is a rare disorder that usually does not affect future children.”
2. “Our newborn looks normal; he may not have galactosemia.”
3. “Our newborn may need to take penicillin and other medications to prevent
infection.”
4. “Penicillin and other drugs that contain lactose as fillers need to be avoided.”
17. Which signs and symptoms would the nurse expect to assess in a newborn with
congenital hypothyroidism?
1. Preterm, diarrhea, and tachycardia.
2. Post-term, constipation, and bradycardia.
3. High-pitched cry, colicky, and jittery.
4. Lethargy, diarrhea, and tachycardia.
18. Which families would be appropriate to refer for genetic counseling?
1. Parents with macrosomic infant.
2. Parents with neonatal abstinence syndrome infant.
3. Couple with a history of planned abortions.
4. Couple with a history of multiple miscarriages.
19. Which statement from parents of a newborn diagnosed with Tay-Sachs disease
indicates successful understanding of the long-term prognosis?
1. “If we give our baby a proper diet, early intervention, and physical therapy, he can
live to adulthood.”
2. “He will have normal development for about 6 months before progressive
developmental delays occur.”
3. “With intense physical therapy and early intervention, we can prevent
developmental delays.”
4. “If we give our baby a lactose-free diet for life, we can minimize developmental
delays and learning disabilities.”
20. Which intervention might the nurse anticipate in a 2-day-old infant diagnosed with
maple syrup urine disease?
1. High-protein, high-amino-acid diet.
2. Low-protein, limited amino-acid diet.
3. Low-protein, low-sodium diet.
4. Phenylalanine-restricted diet.
21. What would be the priority nursing action on finding the varicella vaccine at room
temperature on the shelf in the medication room?
1. Ensure the varicella vaccine’s integrity is intact; if intact, follow the five rights of
medication administration.
2. Do not administer this batch of vaccine.
3. Ensure the varicella vaccine’s integrity is intact; if intact, give the vaccine after
verifying proper physician orders.
4. Ask the mother if the child has had any prior reactions to varicella.
22. Which would be the most therapeutic response for the mother of a 6-month-old who
tells the nurse she does not want her infant to have the DTaP vaccine because the
infant had localized redness the last time she received the vaccine?
1. “I will let the physician know, and we will not administer the DTaP vaccination
today.”
2. “Every child has that allergic reaction, and your child will still get the DTaP
today.”
3. “I will let the physician know that you refuse further immunizations for your
daughter.”
4. “Would you mind if we discussed your concerns?”
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23. Which nursing intervention should take place prior to all vaccination
administrations?
1. Document the vaccination to be administered on the immunization record and
medical record.
2. Provide the vaccine information statement handout, and answer all questions.
3. Administer the most painful vaccination first, and then alternate injection sites.
4. Refer to the vaccination as “baby shots” so the parent understands the baby will
be receiving an injection.
24. Which would be the nurse’s best response if a mother asks if her baby still needs the
Hib vaccine because he already had Hib?
1. “Yes, it is recommended that the baby still get the Hib vaccine.”
2. “No, if he has had Hib, he will not need to receive the vaccine.”
3. “Let me take a nasal swab first; if it is negative, he will receive the Hib vaccine.”
4. “The physician will order a blood test, and depending on results, your child may
need the vaccine.”
25. What would be the nurse’s best response if the foster mother of a 15-month-old with
an unknown immunization history comes to the clinic requesting immunizations?
1. “Your foster child will not receive any immunizations today.”
2. “Your foster child will receive the MMR, Hib, IPV, and hepatitis B vaccines.”
3. “Your foster child could have harmful effects if we revaccinate with prior
vaccines.”
4. “Your foster child will receive only the Hib and DTaP vaccines today.”
26. Which medication is most important to have available in all clinics and offices if
immunizations are administered?
1. Benadryl (diphenhydramine) injection.
2. Benadryl (diphenhydramine) liquid.
3. Epinephrine 1:1000 injection.
4. Epinephrine 1:10,000 injection.
27. Which is the nurse’s best response to the mother of a 2-month-old who is going
to get IPV immunization when the mother tells the nurse the older brother is
immunocompromised?
1. “Your baby should not be immunized because your immunocompromised son
could develop polio.”
2. “Your baby should receive the oral poliovirus vaccine instead so your immunocompromised son does not get sick.”
3. “You should separate your 2-month-old child from the immunocompromised son
for 7 to 14 days after the IPV.”
4. “Your baby can be immunized with the IPV; he will not be contagious.”
28. Which would be the priority intervention for the newborn of a mother positive for
hepatitis antigen?
1. The newborn should be given the first dose of hepatitis B vaccine by 2 months
of age.
2. The newborn should receive the hepatitis B vaccine and hepatitis B immune
globulin within 12 hours of birth.
3. The newborn should receive the hepatitis B vaccine and hepatitis B immune
globulin within 24 hours of birth.
4. The newborn should receive hepatitis B immune globulin within 12 hours
of birth.
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29. Which instruction would be of highest priority for the mother of an infant receiving
his first oral rotavirus vaccine?
1. “Call the physician if he develops fever or cough.”
2. “Call the physician if he develops fever, redness, or swelling at the injection site.”
3. “Call the physician if he develops a bloody stool or diarrhea.”
4. “Call the physician if he develops constipation and irritability.”
30. What would be the best plan of care for a newborn whose mother’s hepatitis B
antigen status is unknown?
1. Give the infant the hepatitis B vaccine within 12 hours of birth.
2. Give the infant the hepatitis B vaccine and hepatitis B immune globulin within
12 hours of birth.
3. Give the infant the hepatitis B vaccine within 24 hours of birth.
4. Give the infant the hepatitis B vaccine and hepatitis B immune globulin within
24 hours of birth.
31. When discharging a newborn, which injury prevention instruction would be of
highest priority to tell the parents?
1. “Place safety locks on all medicine cabinets and household cleaning supplies.”
2. “Transport the infant in the front seat when driving alone so you can see the
baby.”
3. “Never leave the baby unattended on a raised, unguarded area.”
4. “Place safety guards in front of any heating appliance, stove, fireplace, or
radiator.”
32. A 10-month-old is carried into the emergency department by her parents after she
fell down 15 stairs in her walker. Which would be your highest priority nursing
intervention?
1. Assess airway while simultaneously maintaining cervical spine precautions.
2. Assess airway, breathing, and circulation simultaneously.
3. Prepare for diagnostic radiological testing to check for any injuries.
4. Obtain venous access and draw blood for testing.
33. Which would be the most appropriate discharge instructions for a child with a right
wrist sprain 3 hours ago?
1. “You should rest, elevate the wrist above the heart, apply heat wrapped in a towel,
and use the sling when walking.”
2. “You can use the wrist, but stop if it hurts; elevate the wrist when not in use, and
use the sling when walking.”
3. “You should rest, apply ice wrapped in a towel, elevate the wrist above the heart,
and use the sling when walking.”
4. “You do not have to take any special precautions; do not use any movements that
cause pain, and apply alternate heat and ice, each wrapped in a towel.
34. A child with a newly applied left leg cast initially feels fine, then starts to cry and tells
his mother his leg hurts. Which assessment would be the nurse’s first priority?
1. Cast integrity.
2. Neurovascular integrity.
3. Musculoskeletal integrity.
4. Soft-tissue integrity.
35. Which would be the most appropriate injury prevention/safety teaching for an
adolescent?
1. Inquire which are the favorite sports, discuss the teen’s knowledge and application
of appropriate safety principles.
2. Tell the teen to be careful performing sports activities because every sport has the
potential for injury.
3. Tell the teen not to let friends encourage drinking, smoking, or taking drugs.
4. Ask the mother what sports the teen plays and if a helmet is worn with contact
sports.
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36. Which assessment is most important after any injury in a child?
1. History of loss of consciousness and length of time unconscious.
2. Serial assessments of level of consciousness.
3. Initial neurological assessment.
4. Initial vital signs and oxygen saturation level.
37. Which is the most appropriate nursing intervention when caring for a child newly
admitted with a mild head concussion and no cervical spine injury?
1. Keep head of bed flat, side rails up, and safety measures in place.
2. Elevate head of bed, side rails up, and safety measures in place.
3. Observe for drainage from any orifice and notify physician immediately.
4. Continually stimulate the child to keep awake to check neurological status.
38. Which is the most appropriate teaching to the parents of a child in the emergency
department after a near drowning if the child is awake, alert, and has no respiratory
distress?
1. “Your child will most likely be discharged, and you should watch for any cough or
trouble breathing.”
2. “Your child will need to have a preventive tube for breathing and ventilation to
ensure the lungs are clear.”
3. “Your child will be fine but sometimes antibiotics are started as a preventive.”
4. “Your child will most likely be admitted for at least 24 hours and observed for
respiratory distress or any swelling of the brain.”
39. What would be the most appropriate advice to give to the parent of a child with
slight visual blurring after being hit in the face with a basketball?
1. “Apply ice, observe for any further eye complaints, and bring him back if he has
increased pain.”
2. “Take him to the emergency department to ensure that he does not have any
internal eye damage.”
3. “Call your pediatrician if he starts vomiting, is hard to wake up, or has worsening
of eye blurring.”
4. “Observe for any further eye complaints, headaches, dizziness, or vomiting, and if
worsening occurs, take him to your pediatrician.”
40. Which would be the best response to the mother of a 13-year-old who continues to
ask to ride his 16-year-old cousin’s all-terrain vehicle?
1. Emphasize the wearing of safety apparel and adult supervision.
2. Explain that he is developing increased physical skills; if he wears safety apparel
and shows maturity, it should be fine.
3. All-terrain vehicles are not recommended for those younger than 16 years of age.
4. This is a stage where the child is seeking independence and should be allowed to
participate in new physical activities.
41. Which response about safety measures is the most appropriate advice for the
2-year-old’s mother who had her older home remodeled to reduce the lead level?
1. “Wash and dry the child’s hands and face before he eats.”
2. “Remodeling the home to remove the lead is all you need to do.”
3. “It is best to use hot water to prepare the child’s food to decrease the lead.”
4. “Diet does not matter in reducing lead levels in the child.”
42. Which intervention would be most appropriate for a 3-year-old who has just ingested
dish detergent?
1. Discuss childproofing measures in the home in a nonthreatening manner.
2. Inquire about the circumstances of the ingestion.
3. Discuss having ipecac and the Poison Control phone number in the home.
4. Tell the mother you will be giving the boy medicine to make him throw up.
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43. Which would be the most appropriate intervention for a 4-year-old brought to the
emergency department after ingesting a small watch battery?
1. No treatment would be needed; assess and monitor airway, breathing, circulation,
and abdominal pain.
2. Ask the mother the time of the ingestion; if it was more than 2 hours ago, it will
probably pass in his bowel movement.
3. Assess and monitor airway, breathing, circulation, and abdominal pain; anticipate
admission and prepare for surgical intervention.
4. Discuss childproofing measures needed in the home with a 4-year-old child;
provide anticipatory guidance concerning other possible poisonous ingestions.
44. Which nursing intervention would be of highest priority for a 2-year-old suspected
of ingestion digoxin?
1. Provide supplemental oxygen.
2. Establish intravenous access.
3. Draw blood for a STAT digoxin level.
4. Provide continuous cardiac monitoring.
45. Which would be the priority nursing intervention for a child with carbon monoxide
poisoning?
1. Provide supplemental 100% oxygen.
2. Provide continuous oxygen saturation monitoring.
3. Establish intravenous access.
4. Draw blood for a STAT carbon monoxide level.
46. Which would be appropriate anticipatory guidance during the well-care visit of a
17-year-old?
1. Discuss alcohol use and potential for alcohol poisoning.
2. Discuss secondary sex characteristics that will develop.
3. Teach about anger management and safe sex.
4. Teach about peer pressure and desire for independence.
47. Which would be the best response to a 10-year-old who asks if she can take
acetaminophen daily if she gets aches and pains?
1. Tell her it is better not to take medication if she gets aches and pains; she should
check with her mother before taking any medication.
2. Teach her that nonprescription drugs like acetaminophen can be a poisoning
hazard if too many are taken; it is best for her to check with her mother.
3. Encourage her to keep a log of when she takes acetaminophen to try to establish
what is causing her aches and pains.
4. Sometimes it is okay to take acetaminophen daily, but it depends on why she has
aches and pains.
48. What would be the nurse’s best advice to a mother who says her 3-year-old ingested
Visine eye solution?
1. “Initiate vomiting immediately.”
2. “Call the Poison Control Center.”
3. “Call the pediatrician right away.”
4. “Dilute with milk 1:1 volume of suspected ingestion.”
49. What would be the best response to a mother who tells the nurse that the only way
she can get her 2-year-old to take medicine is to call it candy?
1. Tell her that is fine as long as the child takes all of the medicine.
2. Discuss the importance of not calling medicine candy to prevent accidental drug
ingestion.
3. Discuss with the mother that the child does not have to take the medicine if she
does not want it.
4. Tell the mother her child will have to go to “time-out” if she does not take her
medicine.
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50. Which nursing plan would be most successful if the nurse has to administer activated
charcoal to a 5-year-old?
1. Have the parents tell him he has to drink it while providing a movie to
distract him.
2. Tell him it is candy, it tastes good, do not let him look at it, and he will get a toy
after he takes it all down.
3. Mix it with a sweetening flavoring, provide a straw, and give it in an opaque cup
with a cover.
4. Have his mother take some first to show the boy it does not taste too bad, and
then administer it to him quickly.
51. Which statement most accurately describes child abuse?
1. Intentional physical abuse and neglect.
2. Intentional and unintentional physical and emotional abuse and neglect.
3. Sexual abuse of children, usually by an adult.
4. Intentional physical, emotional, and sexual abuse and neglect.
52. What is the most likely cause of a child’s illness if it is unexplained, prolonged,
recurrent, and extremely rare, and usually occurs when the mother is present?
1. Genetic disorder.
2. Munchausen syndrome by proxy.
3. Duchenne muscular dystrophy.
4. Syndrome of inappropriate antidiuretic hormone.
53. Which statement would be most therapeutic to a child the nurse suspects has been
abused?
1. “Who did this to you? This is not right.”
2. “This is wrong that your mother did not protect you.”
3. “This is not your fault; you are not to blame for this.”
4. “I will not tell anyone.”
54. The mother of a 6-month-old states that since yesterday, the infant cries when
anyone touches her arm. Which would be the priority assessment after the airway,
breathing, and circulation had been assessed and found stable?
1. Ask the mother if she knows what happened.
2. Assess infant for other signs of potential physical abuse.
3. Prepare for radiological diagnostic studies.
4. Establish intravenous access, and draw blood for diagnostic testing.
55. Which assessment of an 18-month-old with burns on his feet would cause suspicion
of child abuse?
1. Splash marks on his right lower leg.
2. Burns noted on right arm.
3. Symmetrical burns on both feet.
4. Burns mainly noted on right foot.
56. Which would be the nurse’s priority intervention if a 7-year-old’s mother tells the
nurse she has noticed excessive masturbation?
1. Tell her it is normal development for children of this age.
2. Ask the mother if anyone is abusing the child.
3. Talk with the child and find out why she is touching herself down there.
4. Investigate thoroughly the circumstances in which she masturbates.
57. Which statement by the mother would lead the nurse to suspect sexual abuse in
a 4-year-old?
1. “She has just started masturbation.”
2. “She has lots more temper tantrums.”
3. “She now has an invisible friend.”
4. “She wants to spend time with her sister.”
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58. What would be the priority intervention when a 10-year-old comes to the nurse’s
office because of a headache, and the nurse notices various stages of bruising on the
inner aspects of the upper arms?
1. Call her mother and ask if acetaminophen can be given for the headache.
2. Ask the child what happened to her arms, and have her describe the headache.
3. Inquire about the child’s headache and bruising on her arms; file mandatory
reporting forms.
4. Call her mother to pick her up from school, and complete required school nurse
visit forms.
59. Which statement is true of abused children?
1. They will tell the truth if asked about their injuries.
2. They will repeat the same story that their parents tell.
3. They usually are not noted to have any changes in behavior.
4. They will have outgoing personalities and be active in school activities.
60. Which statement is true of shaken baby syndrome?
1. There may be absence of external signs of injury.
2. Shaken babies usually do not have retinal hemorrhage.
3. Shaken babies usually do not have signs of a subdural hematoma.
4. Shaken babies have signs of external head injury.
61. What would be the best response if the mother of a 10-year-old on kidney dialysis
tells the nurse he has no appetite and only eats bananas?
1. “Right now his stomach is upset, and as long as he is eating something to give
him strength, it is fine.”
2. “Let’s talk about your son and his diet.”
3. “Bananas are good to eat; they are rich in needed nutrients.”
4. “Did you try asking him what else he may want to eat?”
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Weighing the child would be important but
not the priority when concerned about an
infectious cause. Initiating droplet precautions to prevent infecting others would be a
priority, then weighing the infant.
2. The symptoms are not suggestive of a cold
but something more serious. Infants do not
usually lose weight, nor are they irritable
with a simple cold.
3. Children with tuberculosis may have a
history of living in a crowded home or
could be homeless. Other symptoms
may include a cough, cold symptoms,
low-grade fever, irritability, poor
appetite, and exposure to a person
with tuberculosis. Initiation of droplet
precautions and isolation of the infant
would be warranted in this situation.
4. Taking the infant’s temperature is important, but initiating droplet precautions
would be the priority.
TEST-TAKING HINT: The test taker should be
highly suspicious of tuberculosis given the
family and patient history. Health-care
personnel need to be vigilant to contain and
prevent further spread of communicable
diseases. This child could have meningitis,
which would also require isolation and
respiratory precautions.
2. 1. Cardiovascular manifestations of
Kawasaki disease are the major complications in pediatric patients. Continuous
cardiac monitoring is required to alert
the nurse of any cardiovascular complications. Decreased oxygen saturation
and respiratory changes have been
shown to be early indicators of potential
complications.
2. Vital signs would be taken every 1 to
2 hours until stable on a new admission
with Kawasaki disease.
3. Strict intake and output is very important,
but because the major complications with
Kawasaki disease are cardiovascular, continuous cardiac monitoring is the priority.
4. High-dose aspirin therapy is begun and
continued until the child has been afebrile
for 48 to 72 hours; then the child is placed
on low-dose therapy.
TEST-TAKING HINT: The test taker should
understand that cardiovascular manifestations of Kawasaki disease are the major
complications in pediatric patients.
3. 1. With the diagnosis of suspected bacterial
meningitis, the neonate is expected to be
irritable, which frequently accompanies
increased intracranial pressure.
2. A rectal temperature of 38.1°C or 100.6°F
indicates a low-grade fever and is not as
concerning as the slower-than-normal
respiratory rate of 24.
3. The fact the infant is quieter than normal is
in response to the slow respiratory rate and
sepsis the neonate is experiencing.
4. A normal neonate’s respiratory rate is
30 to 60 breaths per minute. Neonates’
respiratory systems are immature, and
the rate may initially double in response
to illness. If no immediate interventions
are begun when there is respiratory distress, a neonate’s respiratory rate will
slow down, develop worsening respiratory distress, and, eventually, respiratory
arrest. Neonates with slower or faster
respiratory rates are true emergency
cases; they require identification of the
cause of distress.
TEST-TAKING HINT: The test taker needs to
know the normal range of vital signs and
when to be concerned to help answer the
question.
4. 1. The rash is pink and maculopapular, not
vesicular. The incubation period is 5 to
15 days and more commonly seen in
children 6 months to 3 years of age.
Isolating the siblings is not necessary.
2. Roseola transmission is unknown
and more commonly seen in children
6 months to 3 years of age, so siblings
do not need to be isolated.
3. Because the siblings have no history of
seizures, it is not necessary to administer
acetaminophen to prevent seizures.
4. Febrile seizures are not usually seen in
children older than 6 years, and because they
have no history of seizures, it is not necessary
to monitor them for seizure development.
TEST-TAKING HINT: The test taker should
understand that exanthema subitum
(roseola) transmission is unknown, and
usually limited to children 6 months to
3 years of age; isolation is not necessary.
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PEDIATRIC SUCCESS
5. 1. Having the physician come back and talk
with the pregnant mother of a 2-year-old
with fifth disease is appropriate, but these
are certainly concerns the nurse can address
by using therapeutic communication.
2. Acknowledging the mother’s fear is therapeutic, and it is appropriate to intervene.
3. Informing the obstetrician would be appropriate after dealing therapeutically with the
mother’s concerns.
4. There is less risk of fetal death in the
second half of the pregnancy. It is more
therapeutic to acknowledge a client’s
fears. After acknowledging her fears, the
appropriate response would be to discuss
concerns and clarify any misconceptions.
TEST-TAKING HINT: The test taker should
understand there is a 10% risk of death if a
mother is exposed to erythema infectiosum
(fifth disease) during the first half of her
pregnancy.
6. 1. The primary source of transmission is secretions from the respiratory tract (droplet) of
infected persons (airborne). Transmission
occurs by direct contact, skin lesions to a
lesser extent, and contaminated objects.
2. Varicella (chickenpox) is highly contagious.
Contact and droplet respiratory precautions should be started immediately
because the primary source of transmission
is secretions of the respiratory tract
(droplet) and also by contaminated objects.
3. Droplet precaution is very important
because that is the primary source of
transmission. Transmission also occurs by
direct contact and contaminated objects.
4. Standard precautions (formerly universal
precautions) should always be maintained;
the term refers to protecting oneself from
patient’s blood or body fluids.
TEST-TAKING HINT: The test taker understands that the primary source of transmission of varicella (chickenpox) is secretions
of the respiratory tract of infected persons
(airborne). Transmission occurs by direct
contact, skin lesions to a lesser extent, and
contaminated objects.
7. 1. To help decrease itching, a cool bath is a
better option. Soap and warm water can
cause more itching.
2. Caladryl lotion contains diphenhydramine (Benadryl), and the child would
be at risk for toxicity if the Caladryl is
applied to open lesions.
3. Caladryl lotion is applied in an amount to
cover the lesions.
4. A cool shower can be soothing and
decrease itching. Mild soap is drying to
the lesions and can cause more itching.
TEST-TAKING HINT: The test taker should
understand that Caladryl lotion contains
Benadryl.
8. 1. Joint pain or arthritis is the most
common symptom of acute rheumatic
fever (60% to 80% of first attacks).
The joint pain usually occurs in two
or more large joints (ankle, knee, wrist,
or elbow).
2. Rheumatic fever usually follows group A
streptococcal infection, and the culture is
usually positive.
3. Large red “bull’s-eye” lesions are more
characteristic of Lyme disease. The rash
associated with rheumatic fever is erythematous with a demarcated border.
4. A stiff neck with photophobia is more
indicative of meningitis.
TEST-TAKING HINT: The test taker should
remember the major and minor criteria of
rheumatic fever to answer this question.
9. 1. The nurse acknowledges a client’s
fears and then discusses the concerns
to clarify any misconceptions. Immunizations and influenza vaccine are
recommended to prevent infection.
Immunocompromised HIV-infected
children should not receive the
varicella and MMR live vaccines.
2. Recommended immunizations for a
12-month-old include varicella and MMR
(live vaccines), which are not administered
to an immunocompromised child.
3. Recommended vaccines will be administered because the child is not immunocompromised.
4. The recommendation is for the child to
receive routine immunizations unless the
child is immunocompromised.
TEST-TAKING HINT: The test taker should
know that families and patients who are
HIV-positive should be taught ways to
prevent infections, including the administration of immunizations.
10. 1. Airway, breathing, and circulation are
part of the primary patient assessment.
Neurological assessment is the next
assessment to perform.
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CHAPTER 3 ISSUES RELATED
2. The child has been diagnosed with
encephalitis. Unless there is a concern
about the child’s having strep throat, a
throat culture would not be obtained.
3. Initial and serial neurological
assessments would be a priority
nursing intervention in a child with a
neurological problem. It is to monitor
for changes in neurological status.
4. Encephalitis is usually caused by a virus
therefore, antibiotics are not ordered.
Antipyretics may be used to help control
fevers.
TEST-TAKING HINT: The test taker should
understand that the primary assessment
includes ensuring patent airway, breathing, circulation, and intact neurological
status. In a child with a neurological
problem, continue monitoring for changes
in neurological status.
11. 1. Cystic fibrosis is inherited as an
autosomal-recessive trait, causing
exocrine gland dysfunction. About
7% to 10% of newborns with cystic
fibrosis present with meconium ileus,
so assessing stool frequency and
consistency is important.
2. Chest physical therapy would not be
initiated in a newborn without a definitive
diagnosis.
3. Assessing weight is important in newborns
because they can lose up to 10% of their
birth weight, and it can take up to 2 weeks
for them to regain their birth weight.
4. The newborn would not be placed on
fluid restriction even if diagnosed with
cystic fibrosis.
TEST-TAKING HINT: The test taker should
understand that cystic fibrosis is inherited
as an autosomal-recessive trait that causes
exocrine gland dysfunction and affects
the respiratory, gastrointestinal, and
reproductive systems.
12. 1. PKU is inherited as an autosomalrecessive trait. The enzyme phenylalanine
hydroxylase controlling the conversion
of phenylalanine to tyrosine is missing.
A low-phenylalanine diet is the treatment
to prevent brain damage.
2. PKU is inherited as an autosomalrecessive trait. The enzyme phenylalanine
hydroxylase controlling the conversion
of phenylalanine to tyrosine is missing.
A low-phenylalanine diet is the treatment
to prevent brain damage.
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PEDIATRIC HEALTH
3. PKU is inherited as an autosomalrecessive trait. The enzyme phenylalanine hydroxylase controlling the conversion of phenylalanine to tyrosine is
missing. A low-phenylalanine diet is
the treatment to prevent brain damage.
4. Breast milk has low amounts of phenylalanine, so the mother can breastfeed with
monitoring of phenylalanine levels in the
infant.
TEST-TAKING HINT: The test taker should
understand that PKU is a genetic inherited autosomal-recessive trait caused by a
missing enzyme. This enzyme is needed
to metabolize the essential amino-acid
phenylalanine.
13. 1. PKU is a genetic autosomal-recessive
inherited trait. Phenylalanine is an essential
amino acid, which makes it impossible to
remove totally from the diet. Treatment is
a low-phenylalanine diet, which includes
some vegetables, fruits, juice, bread, and
starches.
2. Many high-protein foods such as meats
and dairy products are restricted or
eliminated from the diet due to the
high phenylalanine content.
3. High-protein foods such as meat and dairy
products are restricted to small amounts
or eliminated because of their high phenylalanine content.
4. Breast milk contains PKU and, if the
mother wanted to breast feed, the infant
would need careful monitoring of PKU
levels.
TEST-TAKING HINT: The test taker should
understand that PKU is a genetic
autosomal-recessive inherited trait.
Strict, lifelong dietary restrictions
and monitoring are required. Diet
management includes meeting the
child’s nutritional and growth needs
while maintaining phenylalanine levels
within a safe range.
14. 1. High-protein foods like meats and dairy
products are restricted because of their
high phenylalanine content.
2. The sweetener aspartame (NutraSweet,
Equal) should be avoided because it is
converted to phenylalanine in the body.
3. Because of their high-protein content,
dairy products are limited or eliminated
from the diet.
4. The artificial sweetener aspartame
(NutraSweet, Equal) should be avoided
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PEDIATRIC SUCCESS
because it is converted to phenylalanine in the body.
TEST-TAKING HINT: The test taker should
understand how PKU is treated to
successfully answer this question.
15. 1. Galactosemia is a rare autosomalrecessive disorder involving an inborn
error of carbohydrate metabolism. The
hepatic enzyme galactose-1-phosphate
uridyl transferase is absent, causing the
failure of galactose to be converted
into glucose. Glucose builds up in the
bloodstream, which can result in liver
failure, cataracts, and renal tubular
problems. Treatment of galactosemia
involves eliminating all milk and
lactose-containing foods, including
breast milk.
2. Galactosemia is a rare autosomal-recessive
disorder involving an inborn error of carbohydrate metabolism so that all milk and
lactose-containing foods including breast
milk are eliminated.
3. Galactosemia is a rare autosomal-recessive
disorder involving an inborn error of carbohydrate metabolism so that all milk and
lactose-containing foods including breast
milk are eliminated.
4. Galactosemia is a rare autosomal-recessive
disorder involving an inborn error of carbohydrate metabolism so that all milk and
lactose-containing foods including breast
milk are eliminated. Soy protein is the
preferred formula.
TEST-TAKING HINT: The test taker should
understand that galactosemia is a rare
autosomal-recessive disorder involving an
inborn error of carbohydrate metabolism.
16. 1. Galactosemia is a rare genetic autosomalrecessive disorder involving an inborn
error of carbohydrate metabolism that
may affect future children.
2. Infants usually appear normal at birth, but
within a few days of ingesting milk begin
to vomit and lose weight.
3. Many drugs, such as penicillin, contain
unlabeled lactose as filler and need to be
avoided.
4. Many drugs, such as penicillin, contain
unlabeled lactose as filler and need to
be avoided.
TEST-TAKING HINT: The test taker should
understand that galactosemia is a rare
genetic autosomal-recessive disorder
involving an inborn error of carbohydrate
metabolism that may affect future children.
17. 1. Congenital hypothyroidism clinical
manifestations may include bradycardia,
constipation, poor feeding, lethargy,
galactose-1-phosphate uridyl transferase,
jaundice prolonged for more than 2 weeks,
cyanosis, respiratory difficulties, hoarse cry,
large anterior/posterior fontanels, postterm, birth weight greater than 4000 g.
2. Congenital hypothyroidism clinical
manifestations may include bradycardia,
constipation, poor feeding, lethargy,
jaundice prolonged for more than
2 weeks, cyanosis, respiratory difficulties, hoarse cry, large anterior/posterior
fontanels, post-term, and birth weight
greater than 4000 g.
3. High-pitched cry, being colicky and jittery
usually indicate drug withdrawal or a
neurological problem.
4. Congenital hypothyroidism clinical
manifestations may include bradycardia,
constipation, poor feeding, lethargy,
jaundice prolonged for more than 2 weeks,
cyanosis, respiratory difficulties, hoarse
cry, large anterior/posterior fontanels,
post-term, and birth weight greater
than 4000 g.
TEST-TAKING HINT: The test taker needs to
know clinical manifestations of hypothyroidism to answer this question.
18. 1. Macrosomia (large for gestational age)
does not require genetic counseling.
2. Neonatal abstinence syndrome is a term
used to describe a set of symptoms
displayed by infants exposed to chemicals
in utero.
3. Couples with planned abortions would not
need genetic counseling unless there were
genetic problems with children and/or
adults in their families.
4. Couples with a history of multiple
miscarriages, stillbirths, or infertility
should be referred for genetic counseling to try to determine the cause of
their problems with maintaining a
pregnancy.
TEST-TAKING HINT: The test taker should
understand that couples with multiple
miscarriages, stillbirths, or infertility
should be referred to genetic counseling
to assist in a successful pregnancy.
19. 1. Tay-Sachs disease is a genetic disorder in
which the infant has normal development
for the first 6 months. After 6 months,
developmental delays and neurological
worsening occur. Dietary restriction or
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CHAPTER 3 ISSUES RELATED
providing physical therapy does not
change the outcome.
2. Tay-Sachs disease is a genetic disorder
in which the infant has normal development for the first 6 months. After
6 months, developmental delays and
neurological worsening occur. Dietary
restriction or providing physical therapy does not change the outcome.
3. Tay-Sachs disease is a genetic disorder in
which the infant has normal development
for the first 6 months. After 6 months,
developmental delays and neurological
worsening occur. Dietary restriction or
providing physical therapy does not
change the outcome.
4. Tay-Sachs disease is a genetic disorder in
which the infant has normal development
for the first 6 months. After 6 months,
developmental delays and neurological
worsening occur. Dietary restriction or
providing physical therapy does not
change the outcome.
TEST-TAKING HINT: The test taker should
understand that Tay-Sachs disease is a
genetic disorder in which the infant dies
in childhood.
20. 1. Maple syrup urine disease is a genetic
inborn error of metabolism. It is a deficiency of decarboxylase, which is needed
to degrade some amino acids. If left
untreated, altered tone, seizures, and
death can occur.
2. A child with maple syrup urine disease
will be on a low-protein, limited
amino-acid diet for life. Patients
need a diet high in thiamine.
3. A child with maple syrup urine disease will
be on a low-protein, limited amino-acid
diet for life. Patients need a diet high in
thiamine.
4. A child with maple syrup urine disease will
be on a low-protein, limited amino-acid
diet for life. Patients need a diet high in
thiamine.
TEST-TAKING HINT: Maple syrup urine disease is a genetic disorder with restricted
branched-chain amino acids, for example,
valine, leucine, and isoleucine.
21. 1. Varicella vaccine should be kept frozen in
the lyophilized form. After reconstitution,
the varicella vaccine should be given
within 30 minutes to ensure viral potency.
The five rights of patient medication
should always be followed prior to
administration.
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PEDIATRIC HEALTH
2. The varicella vaccine integrity cannot
be assured if the vaccine is at room
temperature, so do not administer.
3. Varicella vaccine should be kept frozen in
the lyophilized form. After reconstitution,
the varicella vaccine should be given within
30 minutes to ensure viral potency. If the
vaccine is not frozen, do not administer.
4. This is an important question to ask the
mother but does not address the questions
of the nurse finding the varicella vaccine
at room temperature.
TEST-TAKING HINT: Varicella vaccine
should be kept frozen in the lyophilized
form. The vaccine diluents can be kept at
room temperature.
22. 1. A common reaction to the DTaP vaccine is
local swelling and redness at the injection
site, which disappears in a few days. The
nurse should not speak for the physician.
2. This local reaction is not considered an
allergic reaction or an indication the child
should not receive this immunization again.
3. The nurse is interpreting what the mother
is stating to include refusal of all vaccines.
4. This is the therapeutic response,
discussing the mother’s concerns about
the immunizations and local reactions.
TEST-TAKING HINT: The test taker needs
to know common local reactions to
immunizations.
23. 1. Written information about the vaccine
should always be given prior to any immunization administered as well as allowing
time for questions. Accurate documentation should always occur after immunizations are given.
2. Written information about the vaccine
should always be given prior to any
immunization administered as well as
allowing time for questions.
3. Administer the most painful immunization
last.
4. The word “shots” has a negative connotation to parents and should be avoided.
TEST-TAKING HINT: The test taker should
understand that the vaccine information
statement must be given and discussed
with the parent before administering the
vaccine.
24. 1. The infant needs the Hib vaccine to
ensure protection against many serious
infections caused by Hib, such as bacterial meningitis, bacterial pneumonia,
epiglottitis, septic arthritis, and sepsis.
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PEDIATRIC SUCCESS
2. The infant needs the Hib vaccine to
ensure protection against many serious
infections caused by Hib, such as bacterial
meningitis, bacterial pneumonia, epiglottitis, septic arthritis, and sepsis.
3. A nasal swab is used to diagnose a
respiratory syncytial virus infection, which
is unrelated to a Hib infection.
4. A blood test does not diagnose previous
Hib infection in a healthy child.
TEST-TAKING HINT: The test taker should
understand that the Hib vaccine protects
against serious infections.
25. 1. The option is to try to determine immunization status by contacting previous
health-care providers for a record of
vaccines received. If previous providers
are unknown, then the child will receive
recommended immunizations for age.
2. MMR, Hib, IPV, or hepatitis B vaccines
would not routinely be due at this visit.
3. There are usually no harmful effects to a
child with unknown immunization status
if revaccinated.
4. Vaccines routinely due at 15 months
include Hib and DTaP. To catch up
missed immunizations the nurse would
need the child’s immunization record
to verify what he has received.
TEST-TAKING HINT: The test taker would
need to know what to do when the child’s
immunization status is unknown.
26. 1. Epinephrine 1:10,000 injection should be
given intravenously only. Most children in
a clinic or office setting receive immunizations during their well-child visit and do
not have intravenous catheters in place for
immediate access. It’s important to have
Benadryl available also but not as important as having epinephrine.
2. Epinephrine 1:10,000 injection should be
given intravenously only. Most children in
a clinic or office setting receive immunizations during their well-child visit and do
not have intravenous catheters in place for
immediate access.
3. Epinephrine 1:1000 injection would be
the drug of choice for subcutaneous
injection if a severe allergic reaction
occurs in an office or clinic setting.
4. Epinephrine 1:10,000 injection should be
given intravenously only. Most children in
a clinic or office setting receive immunizations during their well-child visit and do
not have intravenous catheters in place for
immediate access. Benadryl liquid is
important to have available also, but it is
not as important as having epinephrine
available.
TEST-TAKING HINT: The test taker understands that in all offices and clinics
offering immunizations, epinephrine is
the most important medication to have on
hand in the event of an allergic reaction.
Epinephrine’s usual dose is 0.01 mg/kg of
1:1000 subcutaneous solution.
27. 1. IPV does not contain live poliovirus, so
the virus cannot be transmitted to the
immunocompromised sibling.
2. The oral polio vaccine contains weakened
poliovirus; rarely, the virus can be transmitted to someone immunocompromised.
The virus is shed in the stool.
3. There is no need to isolate the sibling
from the child receiving the inactive
poliovirus vaccine because the virus
cannot be transmitted.
4. The infant’s sibling can and should be
immunized as recommended. The
infant will not shed the poliovirus.
TEST-TAKING HINT: The test taker understands that household contacts and
siblings of immunocompromised children
are able to receive the IPV. They should
not receive the oral poliovirus vaccine
because there is a rare risk of vaccineassociated polio paralysis.
28. 1. The newborn should receive both hepatitis B vaccine and hepatitis B immune
globulin within 12 hours of birth to
prevent hepatitis B infection.
2. The newborn should receive both
hepatitis B vaccine and hepatitis B
immune globulin within 12 hours of
birth to prevent hepatitis B infection.
3. The newborn should receive both
hepatitis B vaccine and hepatitis B
immune globulin within 12 hours of
birth to prevent hepatitis B infection.
4. The newborn should receive both
hepatitis B vaccine and hepatitis B
immune globulin within 12 hours of
birth to prevent hepatitis B infection.
TEST-TAKING HINT: The test taker should
understand that infants born to mothers
positive for hepatitis B antigen should
receive hepatitis B vaccine and hepatitis B
immune globulin within 12 hours of birth
to prevent infection.
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CHAPTER 3 ISSUES RELATED
29. 1. There is a very small incidence of infants
developing intussusception, signaled by
the onset of bloody stool or diarrhea, after
receiving oral rotovirus vaccine. Cough is
not associated with this vaccine.
2. This is an oral vaccine, not an injectable
vaccine.
3. There is a very small incidence of
infants developing intussusception,
signaled by the onset of bloody stool or
diarrhea after receiving oral rotavirus
vaccine.
4. There is a very small incidence of infants
developing intussusception, signaled by
the onset of bloody stool or diarrhea
after receiving oral rotavirus vaccine.
TEST-TAKING HINT: The test taker should
know potential adverse effects from the
oral rotavirus vaccine.
30. 1. Infants born to mothers of unknown hepatitis B antigen status should be given the
hepatitis B immune globulin and hepatitis B
vaccine within 12 hours of birth. If the
mother is positive for hepatitis B antigen,
then the baby should receive the hepatitis B
immune globulin as soon as possible within
12 hours of birth. Timely administration
of the hepatitis B vaccine is important to
prevent passive acquisition of hepatitis B
from the mother.
2. Infants born to mothers of unknown
hepatitis B antigen status should be
given the hepatitis B immune globulin
and hepatitis B vaccine within 12 hours
of birth. If the mother is positive for
hepatitis B antigen, then the baby
should receive the hepatitis B immune
globulin as soon as possible within
12 hours of birth. Timely administration of the hepatitis B vaccine is
important to prevent passive acquisition of hepatitis B from the mother.
3. Infants born to mothers of unknown
hepatitis B antigen status should be given
the hepatitis B immune globulin and
hepatitis B vaccine within 12 hours of
birth. If the mother is positive for hepatitis
B antigen, then the baby should receive the
hepatitis B immune globulin as soon as
possible within 12 hours of birth. Timely
administration of the hepatitis B vaccine is
important to prevent passive acquisition of
hepatitis B from the mother.
4. Infants born to mothers of unknown
hepatitis B antigen status should be given
the hepatitis B immune globulin and
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PEDIATRIC HEALTH
hepatitis B vaccine within 12 hours of
birth. If the mother is positive for hepatitis
B antigen, then the baby should receive the
hepatitis B immune globulin as soon as
possible within 12 hours of birth. Timely
administration of the hepatitis B vaccine is
important to prevent passive acquisition of
hepatitis B from the mother.
TEST-TAKING HINT: The test taker should
understand that infants born to mothers
with unknown hepatitis B antigen status
should be given the hepatitis B vaccine
within 12 hours of birth.
31. 1. The priority is to prevent the infant from
rolling off a raised surface. Placing safety
locks is done when the infant is a few
months old.
2. The infant should be transported in the
middle of the back seat of the vehicle,
which is considered the safest place.
3. The highest priority in newborn injury
prevention is never to leave the baby
unattended on a raised, unguarded
surface. Involuntary reflexes may cause
the infant to move and fall.
4. Placing safety guards is the priority when
the infant is a few months old and mobile.
TEST-TAKING HINT: The test taker knows
developmentally appropriate injury
prevention and then discusses it with
the parent.
32. 1. Priority nursing intervention with
pediatric trauma patients is airway
assessment while maintaining cervical
spine precautions. If the airway is compromised, immediate corrective action
should be taken prior to assessment of
breathing.
2. Assessing airway, breathing, and circulation will be done in that order, not
simultaneously.
3. Diagnostic radiological testing is done
after the child is stabilized.
4. Venous access and blood draws are done
after airway, breathing, and circulation
have been assessed.
TEST-TAKING HINT: The test taker should
understand that pediatric trauma patients
can also have spinal cord injuries and
what the priorities are in those situations.
33. 1. For the first 24 hours, rest, ice, compression, and elevation (RICE) are recommended for acute injury. The wrist should
be kept immobile and elevated.
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PEDIATRIC SUCCESS
2. The wrist should be kept immobile and
elevated.
3. For the first 24 hours, rest, ice,
compression, and elevation (RICE) are
recommended for acute injury.
4. For the first 24 hours, rest, ice, compression, and elevation are recommended for
acute injury.
TEST-TAKING HINT: The test taker should
remember the acronym RICE (rest, ice,
compression, and elevation) or ICES
(ice, compression, elevation, support).
34. 1. Neurovascular integrity should be assessed
first and frequently because neurovascular
compromise may cause serious consequences. Neurovascular integrity should
be assessed using the 5 Ps: increased Pain
out of proportion with injury, Pallor of
extremity, Paresthesia, Pulselessness at
distal part of extremity, and Paralysis post
cast application. Cast integrity would be
assessed, but neurovascular integrity is the
highest priority.
2. Neurovascular integrity should be
assessed first and frequently because
neurovascular compromise may cause
serious consequences. Neurovascular
integrity should be assessed using the
5 Ps: increased Pain out of proportion
with injury, Pallor of extremity,
Paresthesia, Pulselessness at distal
part of extremity, and Paralysis post
cast application.
3. Neurovascular integrity should be assessed
first and frequently because neurovascular
compromise may cause serious consequences. Neurovascular integrity should
be assessed using the 5 Ps: increased Pain
out of proportion with injury, Pallor of
extremity, Paresthesia, Pulselessness at
distal part of extremity, and Paralysis post
cast application. Musculoskeletal integrity
would be assessed after neurovascular
integrity.
4. Neurovascular integrity should be assessed
first and frequently because neurovascular
compromise may cause serious consequences. Neurovascular integrity should
be assessed using the 5 Ps: increased Pain
out of proportion with injury, Pallor of
extremity, Paresthesia, Pulselessness at
distal part of extremity, and Paralysis post
cast application Soft-tissue integrity is
assessed last.
TEST-TAKING HINT: The test taker should
understand that neurovascular integrity
should be assessed first.
35. 1. Adolescence is a time of need for independence and learning to make appropriate decisions. Safety is always a concern,
and tying a safety discussion to the
teen’s interest in sports will help keep
him safe. The nurse needs to inquire
about and build on the teen’s interests
and knowledge.
2. Lecturing to an adolescent would not be
appropriate; the nurse needs to determine
what the teen knows about safety measures for that sport and then build on that
information.
3. Determining whether the teen drinks,
smokes, or uses drugs and what he thinks
about those activities is the first step.
Lecturing is never appropriate.
4. The teen should be addressed directly.
TEST-TAKING HINT: The test taker should
understand that age and developmentally
appropriate injury prevention teachings
are most effective.
36. 1. History of loss of consciousness and
length of time unconscious is important
information, but serial assessments give
current information.
2. Serial assessments of level of
consciousness are the most important
observations of a child after any injury.
That information tells you if the child’s
condition is changing.
3. Initial neurological assessments are important but only provide a baseline.
4. Initial vital signs and oxygen saturation
level give a baseline and help when
looking at serial assessments.
TEST-TAKING HINT: The test taker should
understand that serial observations of the
child’s level of consciousness are the most
important nursing observations.
37. 1. The head of the bed should be elevated to
decrease intracranial pressure. Side rails
should be up to help ensure the child stays
in bed, and age-appropriate safety measures should be instituted.
2. The head of the bed should be elevated
to decrease intracranial pressure. Side
rails should be up to help ensure the
child stays in bed, and age-appropriate
safety measures should be instituted.
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CHAPTER 3 ISSUES RELATED
3. Drainage from the nose or ear would
indicate more severe head injury and
would be reported to the physician. The
priority would be elevating the head of
the bed to decrease intracranial pressure.
4. The child may sleep, but frequent assessments will be made, and the child will be
awakened often.
TEST-TAKING HINT: The test taker should
understand that the appropriate nursing
intervention would be to elevate the head
of the bed to decrease intracranial
pressure.
38. 1. Any child who has had a near-drowning
experience should be admitted for observation. Even if a child does not appear to
have any injury from the event, complications can occur within 24 hours. Respiratory compromise and cerebral edema can
be delayed complications.
2. A ventilation tube would not be inserted
unless she needs it as determined by her
blood gases, x-rays, and clinical picture.
3. Any child who has had a near-drowning
experience should be admitted for
observation. Even if a child does not
appear to have any injury from the event,
complications can occur within 24 hours.
Respiratory compromise and cerebral
edema can be delayed complications.
4. Any child who has had a near-drowning
experience should be admitted for
observation. Even if a child does not
appear to have any injury from the
event, complications can occur within
24 hours after the event. Respiratory
compromise and cerebral edema can
be delayed complications.
TEST-TAKING HINT: The test taker should
understand that respiratory compromise
and cerebral edema may occur 24 hours
after near-drowning. This means that
children with a near-drowning event
should be admitted.
39. 1. Trauma to the eyes and surrounding
structures is the leading cause of blindness
in children. This incident would be considered blunt force trauma to the eyes,
and the child should receive immediate
medical attention.
2. This type of eye injury is considered
blunt force trauma to the eyes, and the
child should be evaluated medically for
assessment and prevention of eye
damage. Slight blurring could indicate
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PEDIATRIC HEALTH
eye injuries, such as detached retina
and hyphema, which need immediate
medical intervention.
3. This type of eye injury is considered
blunt force trauma to the eyes, and the
child should be evaluated medically for
assessment and prevention of eye damage.
Slight blurring could indicate eye injuries,
such as detached retina and hyphema,
which need immediate medical
intervention.
4. This type of eye injury is considered blunt
force trauma to the eyes, and the child
should be evaluated medically for assessment and prevention of eye damage.
Slight blurring could indicate eye injuries,
such as detached retina and hyphema,
which need immediate medical
intervention.
TEST-TAKING HINT: The test taker should
understand that trauma to the eyes and
supporting structures are the leading
cause of blindness in children.
40. 1. The teen may be at the developmental
stage of seeking independence, but
adolescents do not yet have the emotional
or physical development to operate
all-terrain vehicles. The American
Academy of Pediatrics states that those
younger than 16 years should not operate
all-terrain vehicles. Wearing safety
apparel is important in all sports.
2. The teen may be at the developmental
stage of seeking independence, but
adolescents do not yet have the emotional
or physical development to operate
all-terrain vehicles. The American
Academy of Pediatrics states that those
younger than 16 years should not operate
all-terrain vehicles.
3. The teen may be at the developmental
stage of seeking independence, but
adolescents do not yet have the
emotional or physical development to
operate all-terrain vehicles. The
American Academy of Pediatrics states
that those younger than 16 years
should not operate all-terrain vehicles.
4. The teen may be at the developmental
stage of seeking independence, but
adolescents do not yet have the emotional
or physical development to operate
all-terrain vehicles. The American
Academy of Pediatrics states that those
younger than 16 years should not operate
all-terrain vehicles.
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TEST-TAKING HINT: The test taker should
understand that in early adolescence
the teen does not have the physical or
emotional development to handle allterrain vehicles.
41. 1. Washing and drying hands and face,
especially before eating, decreases lead
ingestion.
2. Other measures can be taken to decrease
ingestion of lead, such as washing hands
and face before eating.
3. Hot water absorbs lead more readily than
cold water.
4. Diet does matter; regular meals, adequate
iron, calcium, and less fat help the child
absorb little lead.
TEST-TAKING HINT: The test taker should
understand lead poisoning usually occurs
with hand-to-mouth activity in toddlers.
42. 1. This is not the time to teach about childproofing the home. The parent will feel
guilty, and anxiety would prevent the
parent from remembering the advice.
2. The most therapeutic approach is to
inquire about the circumstances of the
ingestion in a nonjudgmental manner.
3. Ipecac is no longer recommended to be
kept in the home because of the increasing
number of medications where its use is
contraindicated. All households should
have the Poison Control number beside a
telephone or on speed-dial.
4. This is not the time to teach about childproofing the home. The parent will feel
guilty, and anxiety would prevent the
parent from remembering the advice.
TEST-TAKING HINT: The test taker needs
knowledge of therapeutic communication
to answer this question.
43. 1. A battery is considered a corrosive poison,
and medical attention should be sought.
2. Determining the time of ingestion is important, but treatment should be started
when a battery is ingested.
3. Batteries are considered corrosives; the
child will be admitted, and surgery may
be necessary for removal.
4. This is not the time to discuss childproofing measures. The parent would be anxious and feel guilty about the ingestion.
TEST-TAKING HINT: The test taker should
understand that a battery is considered
a poison and that medical attention is
required.
44. 1. Continuous cardiac monitoring would be
the priority because of the bradycardia and
dysrhythmias that can occur with digoxin
toxicity. Oxygen may be needed if there is
enough bradycardia causing a decrease in
oxygen saturation.
2. The priority is to establish continuous
cardiac monitoring. If it is determined
that venous access is necessary, then that
can be established.
3. The digoxin level would be good to know,
but that is not the priority.
4. Bradycardia and cardiac dysrhythmias
are common signs of digoxin toxicity in
children. Continuous cardiac monitoring is the highest priority to detect
dysrhythmias before they became
lethal.
TEST-TAKING HINT: The test taker should
understand that bradycardia and cardiac
dysrhythmia are common signs of digoxin
toxicity in children.
45. 1. 100% oxygen via non-rebreather mask
is given as quickly as possible if carbon
monoxide poisoning is suspected
because the signs and symptoms of
carbon monoxide poisoning are related
to tissue hypoxia.
2. When carbon monoxide enters the blood,
it readily combines with hemoglobin to
form carboxyhemoglobin. Tissue hypoxia
reaches dangerous levels because carbon
monoxide does not release easily. Oxygen
saturation obtained by oximetry will be
normal because oxygen saturation monitoring does not measure dysfunctional
hemoglobin.
3. The priority is to provide supplemental
oxygen, then establish intravenous access.
4. Although a carbon monoxide level may be
ordered, the highest priority nursing
intervention is to administer oxygen.
TEST-TAKING HINT: The test taker should
understand that 100% oxygen via nonrebreather mask is given as quickly as
possible if carbon monoxide poisoning
is suspected.
46. 1. Developmentally appropriate anticipatory guidance for a 17-year-old is to
discuss alcohol use and potential for
alcohol poisoning.
2. The development of secondary sex characteristics would be discussed with a
younger adolescent.
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CHAPTER 3 ISSUES RELATED
3. Discussing their thoughts about anger
management and safe sex would be
initiated with younger teens.
4. Discussions about peer pressure would be
done with younger teens when it is more
prominent.
TEST-TAKING HINT: The test taker should
understand that alcohol poisoning can
occur with binge drinking and should be
discussed during older adolescent well
visits.
47. 1. Tell the child occasional use of acetaminophen for aches and pains is recommended.
Daily use can cause rebound so that when
she stops taking the medication, her aches
and pains will be worse. At this age,
her parents should be involved in her
over-the-counter drug use.
2. Too much acetaminophen can cause liver
damage; she should check with her mother
before taking it.
3. Keeping a log can be helpful in determining what triggers her aches and pains. The
priority would be to recommend that she
not take pain medication daily.
4. If she needs pain medication daily, a
cause needs to be determined.
TEST-TAKING HINT: The test taker needs to
know what would be considered therapeutic management of the child’s pain.
48. 1. Vomiting is contraindicated with this
medication; the best advice is to call
Poison Control first. Visine (topical sympathomimetic) can cause serious or fatal
consequences if even a little is ingested.
2. Calling Poison Control is the first step
for ingestion of any known or unknown
substance. Visine (topical sympathomimetic) can cause serious or fatal
consequences if even a little is
ingested.
3. The parents of any child who has had an
unintentional ingestion should be counseled
to call Poison Control to determine treatment. Visine (topical sympathomimetic) can
cause serious or fatal consequences if even a
little is ingested.
4. Overdoses are not treated with diluted
milk unless indicated.
TEST-TAKING HINT: The test taker should
understand that in cases of drug poisonings, Poison Control should be called
immediately.
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PEDIATRIC HEALTH
49. 1. Medications should never be called candy
to prevent the accidental ingestion of
medication by children who think it is
candy.
2. Medications should never be called
candy to prevent the accidental ingestion of medication by children who
think it is candy.
3. This is one of those instances when the
toddler has to do something he may not
want to do.
4. The medication has to be taken, and the
toddler is not given an option. Going to
“time-out” delays the administration of
the medication.
TEST-TAKING HINT: The test taker should
understand that medication should never
be called candy to prevent accidental
ingestion.
50. 1. Charcoal is odorless and tasteless, but the
black color should be masked. Providing a
movie is a good distraction but is not the
best answer.
2. Never tell a child that medicine is candy
in order to prevent accidental overdose.
3. Mixing charcoal with a sweetening
agent may help the child ingest it.
Children usually like sweeter drinks.
Hiding the black color in an opaque
container with a lid may also make it
more palatable.
4. A parent can help by tasting the charcoal
first, but getting the child to drink it
quickly probably will not happen.
TEST-TAKING HINT: The test taker should
understand that masking the taste and
black color will make the activated
charcoal more tolerable.
51. 1. Child abuse is intentional physical, emotional, and/or sexual abuse and/or neglect.
2. Child abuse is intentional physical, emotional, and/or sexual abuse and/or neglect.
3. Child abuse is intentional physical, emotional, and/or sexual abuse and/or neglect.
4. Child abuse is intentional physical, emotional, and/or sexual abuse and/or neglect.
TEST-TAKING HINT: The test taker needs to
know the definition.
52. 1. Genetic disorders can usually be explained
by specific testing. Munchausen syndrome
by proxy may be the cause of unexplained,
prolonged, rare, recurrent illnesses. It usually occurs when the caregiver is present.
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2. Munchausen syndrome by proxy may
be the cause of unexplained, prolonged,
rare, recurrent illnesses. It usually
occurs when the caregiver is present.
3. Duchenne muscular dystrophy is a genetic
disorder characterized by muscle weakness
usually appearing in the third year of life.
4. Syndrome of inappropriate antidiuretic
hormone results from hypothalamic
dysfunction and is not unexplained.
TEST-TAKING HINT: The test taker needs
to know the definition of Munchausen
syndrome by proxy or else eliminate other
options and make an educated guess.
53. 1. Immediately asking who did this is not
therapeutic.
2. Blaming the mother for not protecting the
child is inappropriate.
3. When communicating with a child you
think may have been abused, it is the
most therapeutic to tell the child it is
not the child’s fault.
4. Someone has to be told, so lying to the
child is not appropriate or therapeutic.
TEST-TAKING HINT: The test taker should
understand that if someone verbalizes
abuse, therapeutic communication is
extremely important to use.
54. 1. The health-care provider’s highest priority should be to try to get the child’s
history information from the parent.
2. Assess the child for other signs of potential physical abuse after you have determined the child is stable. Children who
are physically abused may have other
injuries in various stages of healing.
3. Radiological studies will be ordered, but
more information as to what may have
caused the injury is important information
to obtain.
4. Intravenous access and blood tests may
not be indicated.
TEST-TAKING HINT: The test taker should
understand that history information is
very important in trying to determine the
cause of the arm pain.
55. 1. Burns on both feet are more indicative of
a child being held in hot water, thus indicating abuse.
2. Burns on the arm may or may not indicate
abuse. History information is important to
determine that.
3. Physical abuse has certain characteristics. Symmetrical burns on both feet
indicate abuse.
4. Burns mainly on the right foot might indicate the child got into a tub of hot water
and then got out without putting the
other foot in, which would not indicate
abuse.
TEST-TAKING HINT: The test taker should
understand that physical signs suggestive
of abuse are symmetrical burns with
absence of splash marks.
56. 1. Masturbation is most common in
4-year-olds and during adolescence.
2. Masturbation may indicate sexual abuse.
It is imperative that the nurses do a
thorough investigation if a parent is
concerned about a child’s masturbation.
3. Talking with the child to find out why she
is masturbating would be one component
of a thorough investigation. Children do
not have insight into their behaviors, however, so she may not be able to state why.
4. Masturbation may indicate sexual abuse. It
is imperative that the nurse do a thorough
investigation if a parent is concerned
about a child’s masturbation.
TEST-TAKING HINT: The test taker should
understand that masturbation may
indicate sexual abuse.
57. 1. Sexual exploration may be more prominent during this stage.
2. Increased temper tantrums, increased
sleep disorders, and depression may
indicate sexual abuse.
3. Children develop invisible friends about
this time and this is a normal part of
development.
4. Wanting to spend more time with a
sibling is a part of normal development at
this age.
TEST-TAKING HINT: The test taker should
understand that increased temper
tantrums, increased sleep disorders, and
depression may indicate sexual abuse.
58. 1. The priority at this time is to ensure her
safety. Coming to the school nurse may be
a cry for help.
2. Her safety should be ensured first,
then discuss physical complaints.
School nurses are mandatory reporters
of any suspected child abuse.
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CHAPTER 3 ISSUES RELATED
3. Ensuring the child’s safety is the highest
priority when a health professional suspects child abuse.
4. Ensuring the child’s safety is the highest
priority when a health professional
suspects child abuse.
TEST-TAKING HINT: Accurate assessment,
description, and documentation should be
recorded by the nurse. Child protective
personnel should be notified.
59. 1. Abused children frequently lie about their
injuries from fear about what will happen
to them.
2. Abused children frequently repeat the
same story that their parents tell.
3. Changes in behavior may suggest abuse.
4. Children who are abused may become
withdrawn and not participate in school
activities.
TEST-TAKING HINT: The test taker should
understand that abused children
commonly repeat the same story that
their parents tell to avoid being punished.
60. 1. There may be absence of external signs
of injury in shaken baby syndrome
because the injury can cause retinal
hemorrhage and subdural hematoma.
2. Retinal hemorrhage is indicative of shaken
baby syndrome in an infant without
external signs of injury.
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PEDIATRIC HEALTH
3. Subdural hematoma is indicative of shaken
baby syndrome in an infant without external signs of injury.
4. Infants with shaken baby syndrome do not
usually have signs of external head injury.
TEST-TAKING HINT: The test taker should
understand that there may be an absence
of external signs of injury in shaken baby
syndrome.
61. 1. It would be most therapeutic to discuss
with the mother and child the best foods
to eat and to avoid on a renal diet.
Bananas should be limited because of
their high potassium content. Potassium is
excreted in the urine.
2. It would be most therapeutic to discuss
with the mother and child the best
foods to eat and to avoid on a renal
diet. Bananas should be limited because
of their high potassium content.
3. Bananas are high in potassium, so the
number needs to be limited.
4. It would be most therapeutic to discuss
with the mother and child the best foods
to eat and to avoid on a renal diet.
Bananas should be limited because of
their high potassium content.
TEST-TAKING HINT: The test taker should
know dietary restrictions for a child with
chronic kidney disease.
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Respiratory
Disorders
4
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Albuterol
Antipyretic
Aspirated
Autosomal-dominant
Azotorrhea
Bradycardia
Bronchiectasis
Bronchoscopy
Constipation
Croup
Dysphagia
Edema
Epiglottitis
Eustachian tube
Flovent (fluticasone)
GoLYTELY (polyethylene glycol/electrolyte)
Heimlich maneuver
Otitis media
Pharyngitis
Prednisone
Ribavirin
Singulair (montelukast)
Steatorrhea
Stridor
Subglottic
Synagis (palivizumab)
Tachycardia
Tachypnea
Tonsillectomy
Tracheostomy
Trendelenburg position
Wheezing
ABBREVIATIONS
Arterial blood gas (ABG)
As needed (PRN)
Blood urea nitrogen (BUN)
Chest physiotherapy (CPT)
Complete blood count (CBC)
Cystic fibrosis (CF)
Emergency department (ED)
Hydrogen ion concentration (pH)
Laryngotracheobronchitis (LTB)
Metered dose inhaler (MDI)
Partial thromboplastin time (PTT)
Respiratory syncytial virus (RSV)
Upper respiratory infection (URI)
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QUESTIONS
1. How does the nurse interpret the laboratory analysis of a stool sample containing
excessive amounts of azotorrhea and steatorrhea in a child with cystic fibrosis (CF)?
The values indicate the child is
1. Not compliant with taking her vitamins.
2. Not compliant with taking her enzymes.
3. Eating too many foods high in fat.
4. Eating too many foods high in fiber.
2. Which would the nurse explain to parents about the inheritance of cystic fibrosis?
1. CF is an autosomal-dominant trait passed on from the child’s mother.
2. CF is an autosomal-dominant trait passed on from the child’s father.
3. The child of parents who are both carriers of the gene for CF has a 50% chance of
acquiring CF.
4. The child of a mother who has CF and a father who is a carrier of the gene for CF
has a 50% chance of acquiring CF.
3. The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin
the child’s first chest physiotherapy (CPT) each day. Which is the nurse’s best response?
1. “Thirty minutes before feeding the child breakfast.”
2. “After deep-suctioning the child each morning.”
3. “Thirty minutes after feeding the child breakfast.”
4. “Only when the child has congestion or coughing.”
4. The parent of an infant with cystic fibrosis (CF) asks the nurse how to meet the child’s
increased nutritional needs. Which is the nurse’s best suggestion?
1. “You may need to increase the number of fresh fruits and vegetables you give
your child.”
2. “You may need to advance your child’s diet to whole cow’s milk because it is higher
in fat than formula.”
3. “You may need to change your child to a higher-calorie formula.”
4. “You may need to increase your child’s carbohydrate intake.”
5. The parent of a child with cystic fibrosis (CF) is excited about the possibility of the
child receiving a double lung transplant. What should the parent understand?
1. The transplant will cure the child of CF and allow the child to lead a long and
healthy life.
2. The transplant will not cure the child of CF but will allow the child to have a
longer life.
3. The transplant will help to reverse the multisystem damage that has been caused by CF.
4. The transplant will be the child’s only chance at surviving long enough to graduate
college.
6. A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the
nurse what early respiratory symptoms they should expect to see in their child. Which
is the nurse’s best response?
1. “You can expect your child to develop a barrel-shaped chest.”
2. “You can expect your child to develop a chronic productive cough.”
3. “You can expect your child to develop bronchiectasis.”
4. “You can expect your child to develop wheezing respirations.”
7. A parent asks the nurse what will need to be done to relieve the constipation of her
child who also has cystic fibrosis (CF). Which is the nurse’s best response?
1. “Your child likely has an obstruction and will require surgery.”
2. “Your child will likely be given IV fluids.”
3. “Your child will likely be given MiraLAX.”
4. “Your child will be placed on a clear liquid diet.”
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CHAPTER 4 RESPIRATORY DISORDERS
8. The parents of a 5-week-old have just been told that their child has cystic fibrosis
(CF). The mother had a sister who died of CF when she was 19 years of age. The
parents are sad and ask the nurse about the current projected life expectancy. What is
the nurse’s best response?
1. “The life expectancy for CF patients has improved significantly in recent years.”
2. “Your child might not follow the same course that the mother’s sister did.”
3. “The physician will come to speak to you about treatment options.”
4. The nurse answers their questions briefly, listens to their concerns, and is
available later after they’ve processed the information.
9. A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What
should the nursing care management of this child include?
1. Maintaining strict bedrest.
2. Avoiding contact with family members.
3. Instilling saline nose drops and bulb suctioning.
4. Keeping the head of the bed flat.
10. A school-age child has been diagnosed with nasopharyngitis. The parent is concerned
because the child has had little or no appetite for the last 24 hours. Which is the
nurse’s best response?
1. “Do not be concerned; it is common for children to have a decreased appetite
during a respiratory illness.”
2. “Be sure your child is taking an adequate amount of fluids. The appetite should
return soon.”
3. “Try offering the child some favorite food. Maybe that will improve the appetite.”
4. “You need to force your child to eat whatever you can; adequate nutrition is
essential.”
11. A child’s parent asks the nurse what treatment the child will need for the diagnosis of
strep throat. Which is the nurse’s best response?
1. “Your child will be sent home on bedrest and should recover in a few days without
any intervention.”
2. “Your child will need to have the tonsils removed to prevent future strep infections.”
3. “Your child will need oral penicillin for 10 days and should feel better in a few
days.”
4. “Your child will need to be admitted to the hospital for 5 days of intravenous
antibiotics.”
12. A child is complaining of throat pain. Which statement by the mother indicates
that she needs more education regarding the care and treatment of her daughter’s
pharyngitis?
1. “I will have my daughter gargle with salt water three times a day.”
2. “I will offer my daughter ice chips several times a day.”
3. “I will give my daughter Tylenol every 4 to 6 hours as needed.”
4. “I will ask the nurse practitioner for some amoxicillin.”
13. A school-age child has been diagnosed with strep throat. The parent asks the nurse
when the child can return to school. Which is the nurse’s best response?
1. “Forty-eight hours after the first documented normal temperature.”
2. “Twenty-four hours after the first dose of antibiotics.”
3. “Forty-eight hours after the first dose of antibiotics.”
4. “Twenty-four hours after the first documented normal temperature.”
14. A school-age child is admitted to the hospital for a tonsillectomy. During the nurse’s
post-operative assessment, the child’s parent tells the nurse that the child is in pain.
Which of the following observations would be of most concern to the nurse?
1. The child’s heart rate and blood pressure are elevated.
2. The child complains of having a sore throat.
3. The child is refusing to eat solid foods.
4. The child is swallowing excessively.
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15. The nurse is reviewing discharge instructions with the parents of a child who had a
tonsillectomy 24 hours ago. The parents tell the nurse that the child is a big eater,
and they want to know what foods to give the child for the next 24 hours. What is
the nurse’s best response?
1. “The child’s diet should not be restricted at all.”
2. “The child’s diet should be restricted to clear liquids.”
3. “The child’s diet should be restricted to ice cream and cold liquids.”
4. “The child’s diet should be restricted to soft foods.”
16. Which laboratory result will provide the most important information regarding the
respiratory status of a child with an acute asthma exacerbation?
1. CBC.
2. ABG.
3. BUN.
4. PTT.
17. What is the most important piece of information that the nurse must ask the parent
of a child in status asthmaticus?
1. “What time did your child eat last?”
2. “Has your child been exposed to any of the usual asthma triggers?”
3. “When was your child last admitted to the hospital for asthma?”
4. “When was your child’s last dose of medication?”
18. Which is the nurse’s best response to parents who ask what impact asthma will have
on the child’s future in sports?
1. “As long as your child takes prescribed asthma medication, the child will be fine.”
2. “The earlier a child is diagnosed with asthma, the more significant the symptoms.”
3. “The earlier a child is diagnosed with asthma, the better the chance the child has
of growing out of the disease.”
4. “Your child should avoid playing contact sports and sports that require a lot
of running.”
19. Which statement by the parent of a child using an albuterol inhaler leads the nurse
to believe that further education is needed on how to administer the medication?
1. “I should administer two quick puffs of the albuterol inhaler using a spacer.”
2. “I should always use a spacer when administering the albuterol inhaler.”
3. “I should be sure that my child is in an upright position when administering the
inhaler.”
4. “I should always shake the inhaler before administering a dose.”
20. Which should the nurse administer to provide quick relief to a child with asthma
who is coughing, wheezing, and having difficulty catching her breath?
1. Prednisone.
2. Singulair (montelukast).
3. Albuterol.
4. Flovent (fluticasone).
21. Which child with asthma should the nurse see first?
1. A 12-month-old who has a mild cry, is pale in color, has diminished breath
sounds, and has an oxygen saturation of 93%.
2. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing
bilaterally, and has an oxygen saturation of 93%.
3. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an
oxygen saturation of 92%.
4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright,
and has an oxygen saturation of 93%.
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22. Which breathing exercises should the nurse have an asthmatic 3-year-old child do to
increase her expiratory phase?
1. Use an incentive spirometer.
2. Breathe into a paper bag.
3. Blow a pinwheel.
4. Take several deep breaths.
23. The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to
do to make their home a more allergy-free environment. Which is the nurse’s best
response?
1. “Use a humidifier in your child’s room.”
2. “Have your carpet cleaned chemically once a month.”
3. “Wash household pets weekly.”
4. “Avoid purchasing upholstered furniture.”
24. A parent asks how to care for a child at home who has the diagnosis of viral tonsillitis.
Which is the nurse’s best response?
1. “You will need to give your child a prescribed antibiotic for 10 days.”
2. “You will need to schedule a follow-up appointment in 2 weeks.”
3. “You can give your child Tylenol every 4 to 6 hours as needed for pain.”
4. “You can place warm towels around your child’s neck for comfort.”
25. Which would be an early sign of respiratory distress in a 2-month-old?
1. Breathing shallowly.
2. Tachypnea.
3. Tachycardia.
4. Bradycardia.
26. Which would be appropriate nursing care management of a child with the diagnosis
of mononucleosis?
1. Only family visitors.
2. Bedrest.
3. Clear liquids.
4. Limited daily fluid intake.
27. Which should the nurse instruct children to do to stop the spread of influenza in the
classroom?
1. Stay home if they have a runny nose and cough.
2. Wash their hands after using the restroom.
3. Wash their hands after sneezing.
4. Have a flu shot annually.
28. Who is at the highest priority to receive the flu vaccine?
1. A healthy 8-month-old who attends day care.
2. A 3-year-old who is undergoing chemotherapy.
3. A 7-year-old who attends public school.
4. An 18-year-old who is living in a college dormitory.
29. The parent of a child with influenza asks the nurse when the child is most infectious.
Which is the nurse’s best response?
1. “Twenty-four hours before and after the onset of symptoms.”
2. “Twenty-four hours after the onset of symptoms.”
3. “One week after the onset of symptoms.”
4. “One week before the onset of symptoms.”
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30. A 6-week-old is admitted to the hospital with influenza. The child is crying, and the
father tells the nurse that his son is hungry. The nurse explains that the baby is not to
have anything by mouth. The parent does not understand why the child cannot eat.
Which is the nurse’s best response to the parent?
1. “We are giving your child intravenous fluids, so there is no need for anything by
mouth.”
2. “The shorter and narrower airway of infants increases their chances of aspiration
so your child should not have anything to eat now.”
3. “When your child eats, he burns too many calories; we want to conserve the
child’s energy.”
4. “Your child has too much nasal congestion; if we feed the child by mouth, the
distress will likely increase.”
31. Which statement by the parents of a toddler with repeated otitis media indicates they
need additional teaching?
1. “If I quit smoking, my child may have a decreased chance of getting an ear
infection.”
2. “As my child gets older, he should have fewer ear infections, because his immune
system will be more developed.”
3. “My child will have fewer ear infections if he has his tonsils removed.”
4. “My child may need a speech evaluation.”
32. Which is the nurse’s best response to a parent who asks what can be done at home to
help a child with upper respiratory infection (URI) symptoms and a fever get better?
1. “Give your child small amounts of fluid every hour to prevent dehydration.”
2. “Give your child Robitussin at night to reduce his cough and help him sleep.”
3. “Give your child a baby aspirin every 4 to 6 hours to help reduce the fever.”
4. “Give your child an over-the-counter cold medicine at night.”
33. Which should be included in instructions to the parent of a child prescribed
amoxicillin to treat an ear infection?
1. “Continue the amoxicillin until the child’s symptoms subside.”
2. “Administer an over-the-counter antihistamine with the antibiotic.”
3. “Administer the amoxicillin until all the medication is gone.”
4. “Allow your child to administer his own dose of amoxicillin.”
34. The parent of a child with frequent ear infections asks the nurse if there is anything
that can be done to help avoid future ear infections. Which is the nurse’s best
response?
1. “Your child should be put on a daily dose of Singulair (montelukast).”
2. “Your child should be kept away from tobacco smoke.”
3. “Your child should be kept away from other children with otitis media.”
4. “Your child should always wear a hat when outside.”
35. Which child would benefit most from having ear tubes placed?
1. A 2-month-old who has had one ear infection.
2. A 2-year-old who has had five previous ear infections.
3. A 3-year-old whose sibling has had four ear infections.
4. A 7-year-old who has had two ear infections this year.
36. Which is the nurse’s best response to the parent of an infant diagnosed with the first
otitis media who wonders about long-term effects?
1. “The child could suffer hearing loss.”
2. “The child could suffer some speech delays.”
3. “The child could suffer recurrent ear infections.”
4. “The child could require ear tubes.”
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37. An infant is not sleeping well, crying frequently, has yellow drainage from the ear,
and is diagnosed with an ear infection. Which nursing objective is the priority for
the family?
1. Educating the parents about signs and symptoms of an ear infection.
2. Providing emotional support for the parents.
3. Providing pain relief for the child.
4. Promoting the flow of drainage from the ear.
38. A parent asks the nurse how it will be determined if their child has respiratory
syncytial virus (RSV). Which is the nurse’s best response?
1. “We will do a simple blood test to determine whether your child has RSV.”
2. “There is no specific test for RSV. The diagnosis is made based on the child’s
symptoms.”
3. “We will swab your child’s nose and send that specimen for testing.”
4. “We will have to send a viral culture to an outside lab for testing.”
39. Which statement indicates the parent needs further teaching on how to prevent his
other children from contracting respiratory syncytial virus (RSV)?
1. “I should make sure that both my children receive Synagis (palivizumab)
injections for the remainder of this year.”
2. “I should be sure to keep my infected child away from his brother until he has
recovered.”
3. “I should insist that all people who come in contact with my children thoroughly
wash their hands before playing with them.”
4. “I should insist that anyone with a respiratory illness avoid contact with my
children until well.”
40. Which child is at highest risk for requiring hospitalization to treat respiratory
syncytial virus (RSV)?
1. A 2-month-old who was born at 32 weeks.
2. A 16-month-old with a tracheostomy.
3. A 3-year-old with a congenital heart defect.
4. A 4-year-old who was born at 30 weeks.
41. Which physical findings would be of most concern in an infant with respiratory
distress?
1. Tachypnea.
2. Mild retractions.
3. Wheezing.
4. Grunting.
42. How will a child with respiratory distress and stridor and who is diagnosed with RSV
be treated?
1. Intravenous antibiotics.
2. Intravenous steroids.
3. Nebulized racemic epinephrine.
4. Alternating doses of Tylenol and Motrin.
43. What would the nurse advise the parent of a child with a barky cough that gets worse
at night?
1. Take the child outside into the more humid night air for 15 minutes.
2. Take the child to the ER immediately.
3. Give the child an over-the-counter cough suppressant.
4. Give the child warm liquids to soothe the throat.
44. Which child is in the greatest need of emergency medical treatment?
1. 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions.
2. 6-year-old who has high fever, no spontaneous cough, and frog-like croaking.
3. 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and
a barky cough.
4. 13-year-old who has a high fever, stridor, and purulent secretions.
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45. What information should the nurse provide the parent of a child diagnosed with
nasopharyngitis?
1. Complete the entire prescription of antibiotics.
2. Avoid sending the child to day care.
3. Use comfort measures for the child.
4. Restrict the child to clear liquids for 24 hours.
46. Which assessment is of greatest concern in a 15-month-old?
1. The child is lying down, has moderate retractions, low-grade fever, and nasal
congestion.
2. The child is in the tripod position, has diminished breath sounds, and a muffled
cough.
3. The child is sitting up and has coarse breath sounds, coughing, and fussiness.
4. The child is restless and crying, has bilateral wheezes, and is feeding poorly.
47. Which is diagnostic for epiglottitis?
1. Blood test.
2. Throat swab.
3. Lateral neck x-ray of the soft tissue.
4. Signs and symptoms.
48. What should be the nurse’s first action with a child who has a high fever, dysphagia,
drooling, tachycardia, and tachypnea?
1. Immediate IV placement.
2. Immediate respiratory treatment.
3. Thorough physical assessment.
4. Lateral neck radiographs..
49. Which is the nurse’s best response to the parent of a child diagnosed with epiglottitis
who asks what the treatment will be?
1. Complete a course of intravenous antibiotics.
2. Surgery to remove the tonsils.
3. 10 days of aerosolized ribavirin.
4. No intervention.
50. A mother is crying and tells the nurse that she should have brought her son in
yesterday when he said his throat was sore. Which is the nurse’s best response to
this parent whose child is diagnosed with epiglottitis and is in severe distress and
in need of intubation?
1. “Children this age rarely get epiglottitis; you should not blame yourself.”
2. “It is always better to have your child evaluated at the first sign of illness rather
than wait until symptoms worsen.”
3. “Epiglottitis is slowly progressive, so early intervention may have decreased the
extent of your son’s symptoms.”
4. “Epiglottitis is rapidly progressive; you could not have predicted his symptoms
would worsen so quickly.”
51. The parent of a child with croup tells the nurse that her other child just had croup
and it cleared up in a couple of days without intervention. She asks the nurse why
this child is exhibiting worse symptoms and needs to be hospitalized. Which is the
nurse’s best response?
1. “Some children just react differently to viruses. It is best to treat each child as an
individual.”
2. “Younger children have wider airways that make it easier for bacteria to enter and
colonize.”
3. “Younger children have short and wide eustachian tubes, making them more
susceptible to respiratory infections.”
4. “Children younger than 3 years usually exhibit worse symptoms because their
immune systems are not as developed.”
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52. A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough,
stridor, and hoarseness. Which nursing intervention should the nurse prepare for?
1. Immediate IV placement.
2. Respiratory treatment of racemic epinephrine.
3. A tracheostomy set at the bedside.
4. Informing the child’s parents about a tonsillectomy.
53. Which intervention is most appropriate to teach the mother of a child diagnosed
with a URI and a dry hacking cough that prevents him from sleeping?
1. Give cough suppressants at night.
2. Give an expectorant every 4 hours.
3. Give cold and flu medication every 8 hours.
4. Give 1/2 teaspoon of honey four to five times per day.
54. Which statement about pneumonia is accurate?
1. Pneumonia is most frequently caused by bacterial agents.
2. Children with bacterial pneumonia are usually sicker than children with viral
pneumonia.
3. Children with viral pneumonia are usually sicker than those with bacterial
pneumonia.
4. Children with viral pneumonia must be treated with a complete course of
antibiotics.
55. Which child diagnosed with pneumonia would benefit most from hospitalization?
1. 13-year-old who is coughing, has coarse breath sounds, and is not sleeping well
2. 14-year-old with a fever of 38.6°C (101.5°F), rapid breathing, and a decreased
appetite.
3. 15-year-old who has been vomiting for 3 days and has a fever of 38.5°C (101.3°F).
4. A 16-year-old who has a cough, chills, fever of 38.5°C (101.3°F), and wheezing.
56. Which position would be most comfortable for a child with left-sided pneumonia?
1. Trendelenburg.
2. Left side.
3. Right side.
4. Supine.
57. A child with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide
to the parents?
1. The signs and symptoms of aspiration pneumonia.
2. The treatment plan for aspiration pneumonia.
3. The risks associated with recurrent aspiration pneumonia.
4. The prevention of aspiration pneumonia.
58. A 3-year-old is brought to the ER with coughing and gagging. The parent reports
that the child was eating carrots when she began to gag. Which diagnostic evaluation
will be used to determine if the child has aspirated carrots?
1. Chest x-ray.
2. Bronchoscopy.
3. Arterial blood gas (ABG).
4. Sputum culture.
59. The parent of a 9-month-old calls the ER because his child is choking on a marble.
The parent asks how to help his child while awaiting Emergency Medical Services.
Which is the nurse’s best response?
1. “You should administer five abdominal thrusts followed by five back blows.”
2. “You should try to retrieve the object by inserting your finger in your child’s
mouth.”
3. “You should perform the Heimlich maneuver.”
4. “You should administer five back blows followed by five chest thrusts.”
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60. Which information will be most helpful in teaching parents about the primary
prevention of foreign body aspiration?
1. Signs and symptoms of foreign body aspiration.
2. Therapeutic management of foreign body aspiration.
3. Most common objects that toddlers aspirate.
4. Risks associated with foreign body aspiration.
61. What does the therapeutic management of cystic fibrosis (CF) patients include?
Select all that apply.
1. Providing a high-protein, high-calorie diet.
2. Providing a high-fat, high-carbohydrate diet.
3. Encouraging exercise.
4. Minimizing pulmonary complication.
5. Encouraging medication compliance.
62. A chloride level greater than _____________________ is a positive diagnostic
indicator of cystic fibrosis (CF).
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. The child’s compliance with vitamins would
not be reflected in a lab result of azotorrhea
and steatorrhea. If the patient were not taking daily vitamin supplements, there might
be a deficiency in those vitamins.
2. If the child were not taking enzymes, the
result would be a large amount of undigested food, azotorrhea, and steatorrhea
in the stool. Pancreatic ducts in CF patients become clogged with thick mucus
that blocks the flow of digestive enzymes
from the pancreas to the duodenum.
Therefore, patients must take digestive
enzymes with all meals and snacks to aid
in absorption of nutrients. Often, teens
are noncompliant with their medication
regimen because they want to be like
their peers.
3. Steatorrhea is an increased amount of fat in
the stool. However, in CF patients, it is not
a result of eating too many fatty foods.
4. Azotorrhea is an increased amount of protein
in the stool. Steatorrhea is an increased
amount of fat in the stool. Neither is a result
of eating too many foods high in fiber.
TEST-TAKING HINT: The test taker needs to
understand the pathophysiology of CF
and the impact it has on the gastrointestinal system. The test taker also must be
familiar with the conditions azotorrhea
and steatorrhea.
2. 1. CF is inherited as an autosomal-recessive
trait. Both parents must be carriers of the
gene in order for their children to inherit
the disease. If a child is born to parents who
are both carriers of the CF gene, the child
has a 25% chance of acquiring the disease
and a 50% chance of being a carrier of the
disease. If the child is born to a parent with
CF and the other parent is a carrier, the
child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of
the disease.
2. CF is inherited as an autosomal-recessive
trait. Both parents must be carriers of the
gene in order for their children to inherit
the gene. If a child is born to parents who
are both carriers of the CF gene, the child
has a 25% chance of acquiring the disease
and a 50% chance of being a carrier of the
disease. If the child is born to a parent with
CF and the other parent is a carrier, the
child has a 50% chance of acquiring the
disease and a 50% chance of being a carrier
of the disease.
3. If a child is born to parents who are both
carriers of the CF gene, the child has a
25% chance of acquiring the disease and a
50% chance of being a carrier of the disease.
4. If the child is born to a parent with CF
and the other parent is a carrier, the
child has a 50% chance of acquiring the
disease and a 50% chance of being a
carrier of the disease.
TEST-TAKING HINT: Answers 1 and 2 can be
eliminated with knowledge of the genetic
inheritance of CF. CF is inherited as an
autosomal-recessive trait.
3. 1. CPT should be done in the morning
prior to feeding to avoid the risk of the
child vomiting.
2. Infants with CF are not routinely deepsuctioned. Occasionally, if they have a weak
cough reflex, infants may be suctioned
following CPT to stimulate them to cough.
3. If CPT is done following feeding, it
increases the likelihood that the child
may vomit.
4. CPT should be done as a daily regimen with
all CF patients. CPT helps to break up the
secretions in the lungs and makes it easier
for the patient to clear those secretions.
TEST-TAKING HINT: Answer 4 can be eliminated because of the word “only.” There
are very few times in health care when an
answer will be “only.” Answer 3 can be
eliminated when one considers the risk of
vomiting and aspiration that may occur if
percussion is performed following eating.
4. 1. Children with CF have difficulty absorbing
nutrients because of the blockage of the pancreatic duct. Pancreatic enzymes cannot reach
the duodenum to aid in digestion of food.
These children often require up to 150% of
the caloric intake of their peers. The nutritional recommendation for CF patients is
high-calorie and high-protein.
2. Whole cow’s milk is a good source of fat but
is not an increased source of protein that is
recommended for CF patients. Another consideration here is that whole cow’s milk is
not recommended until 12 months of age.
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3. Often infants with CF need to have a
higher-calorie formula to meet their
nutritional needs. Infants may also be
placed on hydrolysate formulas that
contain medium-chain triglycerides.
4. An increase in carbohydrate intake is not
usually necessary. The nutritional recommendation for CF patients is high-calorie
and high-protein.
TEST-TAKING HINT: Answers 1, 2, and 4 can
be eliminated with understanding of the
nutritional needs of the child with CF.
Answer 2 can also be eliminated because
whole cow’s milk is not recommended
until 12 months of age.
5. 1. A lung transplant does not cure CF, but the
transplanted lungs do not contain the CF
genes. Although the new lungs do not contain CF, the sinuses, pancreas, intestines,
sweat glands, and reproductive tract do. The
new lungs are more susceptible to infection
because of the immunosuppressive therapy
that must be given post transplant. Immunosuppressive drugs make it difficult for the
body to fight infection, which can lead to
lung damage.
2. A lung transplant does not cure CF, but
it does offer the patient an opportunity
to live a longer life. The concerns are
that, after the lung transplant, the child
is at risk for rejection of the new organ
and for development of secondary infections because of the immunosuppressive
therapy.
3. The lung transplant does not reverse the
damage that has been done to the child’s
other organs, but it does offer a chance of a
longer life.
4. The average life span of a patient with CF is
mid-30s. The life span has increased over
the years with the daily regimens of CPT,
exercise, medications, and high-calorie,
high-protein diets.
TEST-TAKING HINT: Answer 4 can be eliminated because of the word “only.” There
are very few times in health care when an
answer will be “only.” Answers 1 and 3 can
be eliminated if the test taker has a basic
knowledge of the pathophysiology of CF.
6. 1. A barrel-shaped chest is a long-term respiratory problem that occurs as a result of recurrent hyperinflation of alveoli.
2. A chronic productive cough is common as
pulmonary damage increases.
3. Bronchiectasis develops in advanced stages
of CF.
4. Wheezing respirations and a dry, nonproductive cough are common early
symptoms in CF.
TEST-TAKING HINT: Answer 2 can be eliminated because of the word “chronic.”
“Chronic” implies that the disease process
is advanced rather than in the initial stages.
Answers 1 and 3 can be eliminated if the
test taker has knowledge of signs and
symptoms of advanced lung disease.
7. 1. CF patients who present with constipation
usually do not require surgery. They
commonly receive a stool softener or an
osmotic solution orally to relieve their
constipation.
2. IV fluids may be ordered if the patient is
NPO for any reason. However, IV fluids do
not help relieve the patient’s constipation.
CF patients with constipation commonly
receive a stool softener or an osmotic solution orally to relieve their constipation.
3. CF patients with constipation commonly
receive a stool softener or an osmotic
solution such as polyethylene glycol 3350
(MiraLAX) orally to relieve their
constipation.
4. CF patients are not placed on a liquid diet
to relieve the constipation. CF patients with
constipation commonly receive a stool softener or an osmotic solution orally to relieve
their constipation. Once the constipation is
relieved, the patient will likely be placed on
a low-fat diet and a stool softener.
TEST-TAKING HINT: Answer 1 can be eliminated because surgery is not indicated
for constipation.
8. 1. The parents are devastated by the new diagnosis and are likely not ready to hear about
the current life expectancy for CF patients.
They are in shock and are trying to deal
with the new diagnosis, so any additional information will just add to their stress level.
2. The mother had a negative experience with
CF in her own family and will likely continue to focus on her past experience with
the disease. It may be more effective to give
her time to consider her son’s diagnosis and
present her with information about current
treatments and life span in a few days.
3. Listening to the parents is an appropriate
intervention. However, having the physician
return with additional information will not
help these parents at this time. They need
time before they are given additional
information.
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4. The nurse’s best intervention is to let
the parents express their concerns and
fears. The nurse should be available if
the parents have any other concerns or
questions or if they just need someone
with whom to talk.
TEST-TAKING HINT: When parents are
given information that their child has a
chronic life-threatening disease, they are
not capable of processing all the information right away; they need time. The
parents are often given more information
than they can possibly understand and
often just need someone to listen to their
concerns and needs.
9. 1. Strict bedrest is not necessary. Children
with respiratory illnesses usually self-limit
their activity. Parents just need to ensure
that their children are getting adequate rest.
2. It is not necessary to avoid contact with
family members. Nasopharyngitis is
spread by contact with the secretions, so
hand washing is the key to limiting the
spread of the virus.
3. Infants are nose breathers and often
have increased difficulty when they are
congested. Nasal saline drops and gentle suctioning with a bulb syringe are
often recommended.
4. The head of the bed should be elevated
in order to help with the drainage of
secretions.
TEST-TAKING HINT: The test taker can
eliminate answer 4 given a basic understanding of interventions to improve
respiratory function.
10. 1. It is common for children to have a decreased appetite when they have a respiratory illness. However, the nurse needs to
instruct the parent to offer fluids to ensure
the child stays hydrated.
2. It is common for children to have a
decreased appetite when they have a
respiratory illness. The nurse is appropriately instructing the parent that
the child will be fine by taking in an
adequate amount of fluid.
3. The child may want to eat some favorite
foods; however, the child will be fine if an
adequate amount of fluid is maintained.
4. The parent should not force the child to
eat; the child’s appetite should return in a
couple of days.
TEST-TAKING HINT: Answer 4 can be eliminated because one should not force the
child to eat. If the word had been “encourage,” it would have been a better choice,
although still not the best answer. Answer
1 can be eliminated because the nurse did
not inform the parent of the importance of
maintaining adequate fluid intake.
11. 1. The child may need bedrest. However, the
child does need antibiotics to treat the
strep infection.
2. The child does not need the tonsils
removed; the child has strep throat.
Surgical removal of the tonsils is done
only following recurrent bouts of
infection.
3. The child will need a 10-day course of
penicillin to treat the strep infection. It
is essential that the nurse always tell the
family that, although the child will feel
better in a few days, the entire course of
antibiotics must be completed.
4. Strep throat can be treated at home with
oral penicillin and does not require IV
antibiotics and hospitalization.
TEST-TAKING HINT: Answer 2 can be eliminated because it is a treatment for recurrent tonsillitis, not strep throat. Answer 1
can be eliminated if the test taker understands that bacterial infections need to be
treated with antibiotics.
12. 1. Gargling with warm salt water is a recommended treatment to relieve some of the
discomfort associated with pharyngitis.
2. Encouraging ice chips is a recommended
treatment to relieve some of the discomfort associated with pharyngitis.
3. Tylenol is a suggested treatment for relief
of discomfort related to pharyngitis
4. Pharyngitis is a self-limiting viral
illness that does not require antibiotic
therapy. Pharyngitis should be treated
with rest and comfort measures,
including Tylenol, throat sprays,
cold liquids, and Popsicles.
TEST-TAKING HINT: Answers 1, 2, and 3
are comfort measures. The question
requires that the student have knowledge
regarding pharyngitis.
13. 1. School systems require that children remain home for 24 hours after having a
documented fever. However, in this question the child has been diagnosed with
strep throat. Even if the child is fever-free,
the child must have completed a 24-hour
course of antibiotics before returning to
school. Children with strep throat are no
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longer contagious 24 hours after initiation
of antibiotic therapy.
2. Children with strep throat are no
longer contagious 24 hours after
initiation of antibiotic therapy.
3. Children with strep throat are no longer
contagious 24 hours after initiation of
antibiotic therapy.
4. School systems require that children
remain home for 24 hours after having a
documented fever. However, in this question the child has been diagnosed with
strep throat. Even if the child is fever-free,
the child must have completed a 24-hour
course of antibiotics before returning to
school. Children with strep throat are no
longer contagious 24 hours after initiation
of antibiotic therapy.
TEST-TAKING HINT: The test taker can eliminate answers 1 and 4 given knowledge of
the communicability of strep throat.
14. 1. The patient is complaining of pain so it is
not unusual that there is an elevated heart
rate and blood pressure. The nurse should
address the pain by giving any PRN pain
medications ordered or calling the
physician for an order.
2. Most children will complain after a
tonsillectomy. This is expected.
3. Oral intake is usually limited to Popsicles,
ice chips, and cold liquids following a tonsillectomy. The child is in pain and should
not be expected to be eating solid foods
8 hours after surgery.
4. Excessive swallowing is a sign that the
child is swallowing blood. This should
be considered a medical emergency,
and the physician should be contacted
immediately. The child is likely bleeding and will need to return to surgery.
TEST-TAKING HINT: Answer 1 can be eliminated if the test taker understands the
common vital-sign changes that occur
when a person is experiencing pain.
15. 1. A child should be restricted to soft foods
for the first couple of days post-operatively.
Soft foods are recommended because the
child will have a sore throat for several days
following surgery. Soft foods will decrease
the risk of bleeding.
2. Most children self-limit their food intake
post-operatively. Children can have solids,
but soft foods are recommended for the
first several post-operative days.
3. Most children prefer to eat cold foods, but
they are not restricted to them.
4. Soft foods are recommended to limit
the child’s pain and to decrease the risk
for bleeding.
TEST-TAKING HINT: The test taker can
eliminate answer 1 by knowing there are
usually some dietary restrictions following
any surgical procedure.
16. 1. The CBC gives the health-care team information about the child’s red and white
blood cell count and hemoglobin and
hematocrit levels. The CBC indicates if
the child has or is developing an infection
but nothing about the child’s current
respiratory status.
2. The ABG gives the health-care team
valuable information about the child’s
respiratory status: level of oxygenation,
carbon dioxide, and blood pH.
3. The BUN provides information about the
patient’s kidney function but nothing regarding the patient’s respiratory status.
4. The PTT provides information about how
long it takes the patient’s blood to clot but
nothing about the patient’s respiratory
status.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2 and 3 with a
knowledge of common laboratory tests.
17. 1. The nurse needs to know when the child
ate last in the event that the child may
need to be intubated for severe respiratory
distress, but it is not the most vital piece
of information to best treat the child for
the current state of distress.
2. The nurse needs to know if the child was
exposed to anything that usually triggers
the asthma, but that is not the most important information for treating the child’s
immediate need.
3. Knowing when the child was admitted last
will give the nurse an idea of the severity
of the child’s asthma, but that is not the
most important information for treating
the child’s immediate need.
4. The nurse needs to know what medication the child had last and when the
child took it in order to know how
to begin treatment for the current
asthmatic condition.
TEST-TAKING HINT: Whereas all of the information here is essential, answer 4 gives the
most important information. The test taker
can eliminate answers 2 and 3 because the
responses to these inquiries have no direct
impact on the immediate treatment of the
child. These two answers give information
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about the severity of the child’s illness, but
they do not affect the immediate treatment
plan. Answer 4 is essential to deciding what
medication should be given the child to
relieve the current symptoms.
18. 1. It is essential that the child take all of the
scheduled asthma medications, but there is
no guarantee the child will be fine and be
able to play all sports.
2. When a child is diagnosed with asthma
at an early age, the child is more likely
to have significant symptoms on aging.
3. Children diagnosed at an early age usually
exhibit worse symptoms than those diagnosed later in life.
4. Children with asthma are encouraged to
participate in sports and don’t necessarily
need bronchodilator medication before,
sports activities. .
TEST-TAKING HINT: The test taker can eliminate answer 4 because not all asthmatics
also have exercise-induced asthma necessitating use of a fast-acting bronchodilator
before playing.
19. 1. The parent should always give one
puff at a time and wait 1 minute before
administering the second puff.
2. A spacer is recommended when administering medications by metered dose
inhaler (MDI) to children.
3. The child should be in an upright position
when medications are administered by MDI.
4. The inhaler should always be shaken before
administering a dose of the medication.
TEST-TAKING HINT: The test taker
evaluates how the parents administer
the MDI.
20. 1. Prednisone, a corticosteroid, is often given
to children with asthma, but it is not a
quick-relief medication. The prednisone will
take time to relieve the child’s symptoms.
2. Singulair is an allergy medication that
should be taken daily by asthmatics with
significant allergies. Allergens are often
triggers for asthmatics, so treating the
child for allergies can help avoid an
asthma attack. Singulair, however, does
not help a child immediately with the
symptoms of a particular asthma attack.
3. Albuterol is the quick-relief bronchodilator of choice for treating an
asthma attack.
4. Flovent is a long-term therapy medication
for asthmatics and is used daily to help
prevent asthma attacks.
TEST-TAKING HINT: The test taker must
know the medications used to treat
asthma and which are used in which
situations.
21. 1. This child is exhibiting signs of severe
asthma. This child should be seen first.
The child no longer has wheezes and
now has diminished breath signs.
2. This child is exhibiting symptoms of mild
asthma and should not be seen before the
other children.
3. This child is exhibiting signs of moderate
asthma and should be watched but is not
the patient of highest priority.
4. This child is exhibiting signs of moderate
asthma and is not the patient of highest
priority.
TEST-TAKING HINT: The test taker can
eliminate answers 2, 3, and 4 by knowing
that diminished breath sounds are a sign
the patient has a worsening condition.
The other bit of information that is
essential in this problem is the child’s
age. The younger the child, the faster
the respiratory status can diminish.
22. 1. A child of 3 years old is too young to
comply with incentive spirometry, and this
activity won’t increase the expiratory
phase anyway.
2. Breathing into a paper bag results in a
prolonged inspiratory and expiratory phase.
3. Blowing a pinwheel is an excellent
means of increasing a child’s expiratory
phase. Play is an effective means of
engaging a child in therapeutic activities. Blowing bubbles is another method
to increase the child’s expiratory phase.
4. Taking deep breaths results in a prolonged
inspiratory phase.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 4 because they do
not increase the expiratory phase. Play is
one of the best ways to engage young
children in therapeutic activities.
23. 1. It is better to maintain 30% to 50%
humidity in homes of asthmatic children.
However, humidifiers are not recommended because they can harbor mold as a
result of lack of proper cleaning.
2. Chemical cleaning is not recommended
because the chemicals used can be a trigger and actually cause the child to have an
asthma attack. The best recommendation
is to remove all carpet from the house, if
possible.
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3. Household pets are not recommended for
children with asthma.
4. Leather furniture is recommended
rather than upholstered furniture.
Upholstered furniture can harbor large
amounts of dust, whereas leather furniture may be wiped off regularly with a
damp cloth.
TEST-TAKING HINT: The test taker can
eliminate answer 3 because there is no
known way to make a pet allergy-free.
Household pets are discouraged for all
children with asthma or severe allergies.
Answer 2 can be eliminated if the test
taker understands that chemical agents
are triggers to asthma for many children.
24. 1. A viral illness does not require antibiotics.
The patient would need to complete a
course of antibiotics for bacterial tonsillitis.
2. Viral tonsillitis is usually a self-limiting
disease and does not require a follow-up
appointment unless the child’s symptoms
worsen.
3. Tylenol is recommended PRN for
pain relief.
4. Warm compresses to the neck are not
recommended, as they may in fact increase
the inflammation. Cold compresses or ice
packs are recommended for comfort.
TEST-TAKING HINT: The test taker can
eliminate answer 1 by knowing that antibiotics are not given for viral illnesses.
Answer 4 can be eliminated by knowing
that swelling and inflammation increase
with heat. Cold causes vasoconstriction of
the vessels, aiding in decreasing the
amount of inflammation.
25. 1. Shallow breathing is a late sign of
respiratory distress.
2. Tachypnea is an early sign of distress
and is often the first sign of respiratory
illness in infants.
3. Tachycardia is a compensatory response by
the body. When a child has respiratory
distress and is not oxygenating well, the
body increases the heart rate in an attempt
to improve oxygenation.
4. Bradycardia is a late sign of respiratory
distress.
TEST-TAKING HINT: The test taker must
know the signs and symptoms of respiratory
distress and be able to recognize them.
26. 1. Children with mononucleosis are more
susceptible to secondary infections.
Therefore, they should be limited to
visitors within the family, especially
during the acute phase of illness.
2. Children with mononucleosis do not need
to be forced to be on bedrest. Children
usually self-limit their behavior.
3. Children with mononucleosis do not need
a restricted diet. Often they are very tired
and are not interested in eating. The
nurse and family must ensure that the
children are taking in adequate nutrition.
4. Children with mononucleosis usually have
decreased appetite, but it is essential that
they remain hydrated. There is no reason
to restrict fluid.
TEST-TAKING HINT: The test taker can
eliminate answers 2 and 3 by understanding mononucleosis. Children with
mononucleosis are usually very tired, are
not interested in engaging in vigorous activity, and are rarely interested in eating.
27. 1. Children do not need to stay home unless
they have a fever. However, the children
should be taught to cough or sneeze into
their sleeve and to wash their hands after
sneezing or coughing.
2. Children should always wash their hands
after using the restroom. In order to decrease the spread of influenza, however, it
is more important for the children to wash
their hands after sneezing or coughing.
3. It is essential that children wash their
hands after any contact with nasopharyngeal secretions.
4. Children should have a flu shot annually,
but that information is best included in an
educational session for the parents. There
is little that children can do directly to ensure they receive flu shots. Children of
this age are often frightened of shots and
would not likely pass that information on
to their parents.
TEST-TAKING HINT: Answers 1 and 4 can be
eliminated because both situations are
under parental control.
28. 1. Children between the ages of 6 and
23 months are at the highest risk for
having complications as a result of the
flu. Their immune systems are not as
developed, so they are at a higher risk
for influenza-related hospitalizations.
2. The flu vaccine should not be given to
anyone who is immunocompromised.
3. The flu vaccine is recommended for all
ages, but the 7-year-old is not the highest
priority. A child this age will likely recover
without any complications.
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4. The flu vaccine is recommended for all
ages, but the 18-year-old is not the highest
priority. A person this age will likely
recover without any complications.
TEST-TAKING HINT: The test taker can
eliminate answers 2 and 3 by knowing
that infants and the elderly are at highest
risk for complications related to the flu.
29. 1. Influenza is most contagious 24 hours
before and 24 hours after onset of
symptoms.
2. Influenza is most contagious 24 hours before
and 24 hours after onset of symptoms.
3. Influenza is most contagious 24 hours before
and 24 hours after onset of symptoms.
4. Influenza is most contagious 24 hours before
and 24 hours after onset of symptoms.
TEST-TAKING HINT: This question requires
the test taker to have knowledge of the
communicability of influenza.
30. 1. The child is receiving intravenous fluids,
so he is being hydrated. However, this response does not explain to the father why
his son cannot eat.
2. Infants are at higher risk of aspiration
because their airways are shorter and
narrower than those of adults. An
infant with influenza has lots of nasal
secretions and coughs up mucus. With
all the secretions, the infant is at an
even higher risk of aspiration.
3. Eating burns calories, but if the baby is
upset and crying he is also expending
energy. Therefore, this is not the best
choice of answers.
4. If the child has nasal congestion, that may
make it difficult for him to feed. However,
the recommendation to parents is to bulbsuction an infant with nasal congestion
before feeding.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because it does not
give the father an explanation of why his
son cannot eat.
31. 1. Repeated exposure to smoke damages the
cilia in the ear, making the child more
prone to ear infections.
2. Children experience fewer ear infections
as they age because their immune system
is maturing.
3. Removing children’s tonsils may not
have any effect on their ear infection.
Children who have repeated bouts of
tonsillitis can have ear infections secondary to the tonsillitis, but there is no
indication in this question that the
child has a problem with tonsillitis.
4. Children who have repeated ear infections
are at a higher risk of having decreased
hearing during and between infections.
Hearing loss directly affects a child’s
speech development.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 4 because
those options are true.
32. 1. It is essential that parents ensure their
children remain hydrated during a URI.
The best way to accomplish this is by
giving small amounts of fluid frequently.
2. Over-the-counter cough and cold medicine is not recommended for any child
younger than 6 years.
3. Aspirin is not given to children to treat a
viral infection because of the risk of developing Reye syndrome.
4. Over-the-counter cough and cold medicine is not recommended for any child
younger than 6 years.
TEST-TAKING HINT: The test taker can
eliminate answers 2 and 4 because overthe-counter cold and cough medications
are not recommended for infants.
33. 1. The parent should administer all of the
medication. Stopping the medication
when symptoms subside may not clear up
the ear infection and may actually cause
more severe symptoms.
2. Antihistamines have not been shown to
decrease the number of ear infections a
child gets.
3. It is essential that all the medication be
given.
4. The child is old enough to participate in the
administration of medication but should
only do so in the presence of the parents.
TEST-TAKING HINT: Answer 1 can be eliminated because a course of antibiotics
should always be completed as ordered,
no matter what the age of the child. Answer 4 can be eliminated because children
would not be expected to administer their
own medications without supervision by
an adult.
34. 1. Singulair is an allergy medication, but it
has not been proven to help reduce the
number of ear infections in children.
2. Tobacco smoke has been proved to
increase the incidence of ear infections. The tobacco smoke damages
mucociliary function, prolonging the
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inflammatory process and impeding
drainage through the eustachian tube.
3. Otitis media is not transmitted from one
child to another. Otitis is often preceded
by a URI, so children who are around
other children with URIs may contract
one, increasing their chances of developing an ear infection.
4. Wearing a hat outside will have no
impact on whether a child contracts an
ear infection.
TEST-TAKING HINT: The test taker can eliminate answer 3 by understanding that otitis
media is not a contagious disease process.
Answer 4 can be eliminated if the test
taker understands that otitis media is not
caused by exposing the child to cold air.
35. 1. Surgical intervention is not a first line of
treatment. Surgery is usually reserved for
children who have suffered from recurrent
ear infections.
2. A 2-year-old who has had multiple ear
infections is a perfect candidate for
ear tubes. The other issue is that a
2-year-old is at the height of language
development, which can be adversely
affected by recurrent ear infections.
3. Surgery is not a prophylactic treatment.
Just because the sibling has had several
ear infections does not suggest that the
3-year-old will also have frequent ear
infections. The 3-year-old has not had an
ear infection yet.
4. A 7-year-old who has had two ear infections is not the appropriate candidate.
Surgical intervention is usually reserved
for children who have suffered from
recurrent ear infections.
TEST-TAKING HINT: The test taker must
also consider the developmental level of
the child in this question. The 2-year-old
has had multiple infections and is also at a
stage when language development is
essential. If this child is not hearing
appropriately, speech will also be delayed.
Surgical intervention is reserved for those
who have had recurrent infections.
36. 1. Hearing loss is not an issue that would be
discussed following one ear infection. Children with recurrent untreated ear infections
are more likely to develop hearing loss.
2. Speech delays are not an issue that would
be discussed following one ear infection.
Children with recurrent untreated ear infections are more likely to develop some
hearing loss, which often results in
delayed language development.
3. When children acquire an ear infection
at such a young age, there is an increased risk of recurrent infections.
4. Surgical intervention is not a first line of
treatment. Surgery is usually reserved for
children who have suffered from recurrent
ear infections.
TEST-TAKING HINT: Answers 1, 2, and 4
can be eliminated if the test taker understands that these are all long-term effects
of recurrent ear infections. The question
is asking about a single incident of otitis.
37. 1. It is important to educate the family about
the signs and symptoms of an ear infection, but that is not the priority at this
time. The infant has already been diagnosed with the infection.
2. The parents may need emotional support
because they are likely suffering from a
lack of sleep because their infant is ill.
However, this will not solve their current
problems with their infant.
3. Providing pain relief for the infant is
essential. With pain relief, the child
will likely stop crying and rest better.
4. Promoting drainage flow from the ear is
important, but providing pain relief is the
highest priority.
TEST-TAKING HINT: The test taker needs to
consider the needs of the child and the
parent at this time. If the pain is controlled,
the parents and child will both be in a better
state. The other items are all essential in
providing care for the child with otitis,
but pain relief offers the best opportunity
for the child and the parent to return to
normal conditions.
38. 1. RSV is not diagnosed by a blood test.
2. Nasal secretions are tested to determine if
a child has RSV.
3. The child is swabbed for nasal secretions.
The secretions are tested to determine if
a child has RSV.
4. Viral cultures are not done very often
because it takes several days to receive
results. The culture does not have to be
sent to an outside lab for evaluation.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 4 because the
child’s nasal sections will be swabbed.
39. 1. Synagis will not help the child who has
already contracted the illness. Synagis
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is an immunization and a method of
primary prevention.
2. RSV is spread through direct contact
with respiratory secretions, so it is a good
idea to keep the ill child away from the
healthy one.
3. RSV is spread through direct contact with
respiratory secretions, so it is a good idea
to have all persons coming in contact with
the child wash their hands.
4. RSV is spread through direct contact with
respiratory secretions, so it is a good idea
to have ill persons avoid any contact with
the children until they are well.
TEST-TAKING HINT: This question requires
the test taker to understand how RSV is
transmitted and how to prevent the spread
of the virus.
40. 1. The younger the child, the greater the
risk for developing complications related
to RSV. This infant is at highest risk
because of age and premature status.
2. This child has a tracheostomy, but this is
not an indication that the child cannot
be managed at home.
3. Most children with RSV can be managed
at home. Children 2 years and younger are
at highest risk for developing complications related to RSV. Children who were
born prematurely, have cardiac conditions,
or have chronic lung disease are also at
higher risk for needing hospitalization.
The 3-year-old with a congenital heart
disease is not the highest risk among this
group of patients.
4. Children who were born prematurely,
have cardiac conditions, or have chronic
lung disease are at a higher risk for needing hospitalization. This child was a premature infant but is now 4 years of age.
TEST-TAKING HINT: The test taker must
consider that all of these children have
some amount of risk for requiring hospitalization. The 2-month-old has two of
the noted risk factors of being premature
and a very young infant.
41. 1. Tachypnea, an increase in respiratory rate,
should be monitored but is a common
symptom of respiratory distress.
2. Retractions should be monitored; they can
occur with respiratory distress.
3. Wheezing should be monitored, and can
occur with respiratory distress.
4. Grunting is a sign of impending respiratory failure and is a very concerning
physical finding.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 3 by knowing
the signs of respiratory distress. They
warrant frequent respiratory assessment,
but they are not the most concerning
physical signs.
42. 1. RSV is a viral illness and is not treated
with antibiotics.
2. Steroids are not used to treat RSV.
3. Racemic epinephrine promotes
mucosal vasoconstriction.
4. Tylenol and Motrin can be given to the
child for comfort, but they do not improve
the child’s respiratory status.
TEST-TAKING HINT: This is a knowledgelevel question that requires the test taker
to know how RSV is treated.
43. 1. The night air will help decrease
subglottic edema, easing the child’s
respiratory effort. The coughing
should diminish significantly, and the
child should be able to rest comfortably. If the symptoms do not improve
after taking the child outside, the
parent should have the child seen by
a health-care provider.
2. There is no immediate need to bring the
child to the ER. The child’s symptoms will
likely improve on the drive to the hospital
because of the child’s exposure to the
night air.
3. Over-the-counter cough suppressants
are not recommended for children
because they reduce their ability to
clear secretions.
4. Warm liquids may increase subglottic
edema and actually aggravate the child’s
symptoms. Cool liquid or a Popsicle is the
best choice.
TEST-TAKING HINT: The test taker must
accurately identify that the question is
describing a child with croup and know
how croup is treated.
44. 1. This child has signs and symptoms of
acute laryngitis and is not in a significant
amount of distress.
2. This child has signs and symptoms of
epiglottitis and should receive immediate emergency medical treatment. The
patient has no spontaneous cough and
has a frog-like croaking because of a
significant airway obstruction.
3. This child has signs and symptoms of
LTB and is not in significant respiratory
distress.
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4. This child has signs and symptoms of
bacterial tracheitis and should be treated
with antibiotics but is not the patient in
the most significant amount of distress.
TEST-TAKING HINT: The test taker must
accurately identify that the question is
describing a child with epiglottitis. The test
taker must also understand that epiglottitis
is a pediatric emergency and can cause the
child to have complete airway obstruction.
45. 1. Nasopharyngitis is a viral illness and does
not require antibiotic therapy.
2. Children who attend day care are more
prone to catching viral illnesses, but it is
not the nurse’s place to tell the parents not
to send their child to day care. Often
families do not have a choice about
using day care.
3. Nursing care for nasopharyngitis is
primarily supportive. Keeping the child
comfortable during the course of the
illness is all the parents can do. Nasal
congestion can be relieved using
normal saline drops and bulb suction.
Tylenol can also be given for discomfort or a mild fever.
4. There is no reason to restrict the child
to clear liquids. Many children have a
decreased appetite during a respiratory
illness, so the most important thing is to
keep them hydrated.
TEST-TAKING HINT: This question
requires the test taker to understand
how nasopharyngitis is treated.
46. 1. Retractions indicate some degree of respiratory distress but more information needs
to be obtained. Other common symptoms
of a respiratory illness include, low-grade
fever, and nasal congestion and are not
overly concerning.
2. When children are sitting in the tripod
position, they are having difficulty
breathing. The child is sitting and
leaning forward in order to breathe
more easily. Diminished breath sounds
are indicative of a worsening condition.
A muffled cough indicates that the
child has some subglottic edema. This
child has several signs and symptoms of
a worsening respiratory condition.
3. Coarse breath sounds, cough, and fussiness are common signs and symptoms of a
respiratory illness.
4. Restlessness, wheezes, poor feeding, and
crying are signs and symptoms of a respiratory illness.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 3, and 4 if familiar
with common signs and symptoms of
respiratory illness.
47. 1. A blood test does not indicate a diagnosis
of epiglottitis. A CBC may show an increased white blood cell count indicating
the child has some sort of infection.
2. A throat culture is not done to diagnose
epiglottitis. It is contraindicated to insert
anything into the mouth or throat of any
child who is suspected of having epiglottitis. Inserting anything into the throat
could cause the child to have a complete
airway obstruction.
3. A lateral neck x-ray is a definitive test
to diagnose epiglottitis. The child is at
risk for complete airway obstruction
and should always be accompanied by a
nurse to the x-ray department.
4. Epiglottitis is not diagnosed based on
signs and symptoms. A lateral neck film
makes the diagnosis.
TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because epiglottitis is diagnosed by lateral neck films.
48. 1. This child is exhibiting signs and symptoms of epiglottitis and should be kept as
comfortable as possible. Agitating the
child may cause increased airway swelling
and may lead to complete obstruction.
2. Respiratory treatments often frighten
children. This child is exhibiting signs and
symptoms of epiglottitis and should be
kept as comfortable as possible. Agitating
the child may cause increased airway
swelling and may lead to complete
obstruction.
3. This child is exhibiting signs and symptoms of epiglottitis and should be kept as
comfortable as possible. Agitating the
child may cause increased airway swelling
and may lead to complete obstruction.
The child should be allowed to remain on
the parent’s lap and kept as comfortable as
possible until a lateral neck film is obtained.
4. This child is exhibiting signs and
symptoms of epiglottitis and should be
kept as comfortable as possible. The
child should be allowed to remain in
the parent’s lap until a lateral neck film
is obtained for a definitive diagnosis.
TEST-TAKING HINT: The test taker must
accurately identify that the question is
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describing a child with epiglottitis and
understand that agitation in this child can
result in complete airway obstruction.
49. 1. Epiglottitis is bacterial in nature
and requires intravenous antibiotics.
A 7- to 10-day course of oral antibiotics is usually ordered following the
intravenous course of antibiotics.
2. Surgery is not the course of treatment for
epiglottitis. Epiglottal swelling usually
diminishes after 24 hours of intravenous
antibiotics.
3. Ribavirin is an antiviral medication used
to treat RSV.
4. Epiglottitis is a bacterial infection; a
course of intravenous antibiotics is
indicated.
TEST-TAKING HINT: Understanding that
epiglottitis is bacterial in nature will lead
the test taker to choose the correct answer.
50. 1. Epiglottitis is most common in children
from 2 to 5 years of age. The onset is very
rapid. Telling parents not to blame themselves is not effective. Parents tend to
blame themselves for their child’s illnesses
even though they are not responsible.
2. The nurse should not tell the parent to
seek medical attention for any and all
signs of illness.
3. Epiglottitis is rapidly progressive and
cannot be predicted.
4. Epiglottitis is rapidly progressive and
cannot be predicted.
TEST-TAKING HINT: When something happens to a child, the parents always blame
themselves. Telling them epiglottitis is
rapidly progressive may be helpful.
51. 1. All children should be treated as individuals
when they are being treated for a particular
illness. However, most children exhibit similar symptoms when they have the same
diagnosis. Younger children have worse
symptoms than older children because
their immune systems are less developed.
2. Children have airways that are shorter and
narrower than those of adults. As children
age, their airways begin to grow in length
and diameter.
3. Children are more prone to ear infections
because they have eustachian tubes that
are short and wide and lie in a horizontal
plane.
4. Younger children have less developed
immune systems and usually exhibit
worse symptoms than older children.
TEST-TAKING HINT: Answer 1 can be eliminated because it does not directly address
the mother’s question. Answer 2 can be
eliminated if the test taker has knowledge
of the anatomical structure of a child’s
airway. Answer 3 can be eliminated
because the eustachian tubes have no
direct relationship to acquiring croup.
52. 1. The child is exhibiting signs and symptoms
of croup and is in mild respiratory distress.
2. The child has stridor, indicating airway
edema, which can be relieved by
aerosolized racemic epinephrine.
3. A tracheostomy is not indicated for this
child. A tracheostomy would be indicated
for a child with a complete airway
obstruction.
4. This child is exhibiting signs and symptoms of croup and has no indication of
tonsillitis. A tonsillectomy is usually
reserved for children who have recurrent
tonsillitis.
TEST-TAKING HINT: The test taker must
accurately identify that the question is
describing a child with croup and know
the accepted treatments.
53. 1. Cough suppressants are not recommended
for children. Coughing is a protective
mechanism, so do not try to stop it.
2. Expectorants are not recommended for
children younger than 6 years of age.
There is no research information that they
are effective.
3. Cold and flu medications are not indicated
for children younger than 6 years of age as
there is no indication they are effective.
4. Warm fluids, humidification, and honey
are best treatments for a URI.
TEST-TAKING HINT: The latest recommendations for treatment of URIs in children
are to treat the symptoms because cough
medications are not effective.
54. 1. Pneumonia is most frequently caused by
viruses but can also be caused by bacteria
such as Streptococcus pneumoniae.
2. Children with bacterial pneumonia are
usually sicker than children with viral
pneumonia. Children with bacterial
pneumonia can be treated effectively,
but they require a course of antibiotics.
3. Children with viral pneumonia are not usually as ill as those with bacterial pneumonia.
Treatment for viral pneumonia includes
maintaining adequate oxygenation and
comfort measures.
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4. Treatment for viral pneumonia includes
maintaining adequate oxygenation and
comfort measures.
TEST-TAKING HINT: The test taker must
have an understanding of the differences
between viral and bacterial infections.
55. 1. These are all common symptoms of pneumonia and should be monitored but do
not require hospitalization. Most people
with pneumonia are treated at home, with
a focus on treating the symptoms and
keeping the patient comfortable. Comfort
measures include cool mist, chest physiotherapy (CPT), antipyretics, fluid intake,
and family support.
2. These are all common symptoms of
pneumonia and should be monitored
but do not require hospitalization.
3. The teen who has been vomiting for
several days and is unable to tolerate
oral fluids and medication should be
admitted for intravenous hydration.
4. These are all common symptoms of pneumonia and should be monitored but do
not require hospitalization.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 4 if familiar
with the common signs and symptoms of
pneumonia.
56. 1. The Trendelenburg position is not effective for improving respiratory difficulty.
Patients with pneumonia are usually most
comfortable in a semi-erect position.
2. Lying on the left side may provide the
patient with the most comfort. Lying
on the left splints the chest and
reduces the pleural rubbing.
3. It is most comfortable for the patient to
lie on the affected side. Lying on the left
splints the chest and reduces the pleural
rubbing.
4. Lying in the supine position does not
provide comfort for the patient and does
not improve the child’s respiratory effort.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 4 because neither
of them would improve the child’s respiratory effort. Both these positions may
actually cause the patient increased
respiratory distress.
57. 1. The nurse should teach the parents about
the signs and symptoms of aspiration
pneumonia, . The most valuable information relates to preventing aspiration pneumonia from occurring in the future.
2. The nurse should instruct the parents on
the treatment plan of aspiration pneumonia, but that is not the most beneficial
piece of information the nurse can provide.
The most valuable information relates to
preventing aspiration pneumonia from
occurring in the future.
3. The nurse should instruct the parents on
the risks associated with recurrent aspiration pneumonia, but that is not the most
beneficial piece of information the nurse
can provide. The most valuable information relates to preventing aspiration
pneumonia from occurring in the future.
4. The most valuable information the
nurse can give the parents is how to
prevent aspiration pneumonia from
occurring in the future.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 3 because they
are all forms of tertiary prevention. Primary prevention is key to maximizing this
child’s function.
58. 1. A chest x-ray will only show radiopaque
items (items that x-rays cannot go through
easily), so it is not helpful in determining
if the child aspirated a carrot.
2. A bronchoscopy will allow the physician to visualize the airway and will
help determine if the child aspirated
the carrot.
3. A blood gas will identify whether the child
has suffered any respiratory compromise,
but the blood gas cannot definitively determine the cause of the compromise.
4. A sputum culture may be helpful several
days later to determine if the child has
developed aspiration pneumonia. Aspiration
pneumonia may take several days or a week
to develop following aspiration.
TEST-TAKING HINT: Answer 1 can be eliminated because items that are not radiopaque
(opaque to x-rays) cannot be seen on an
x-ray. Answers 3 and 4 can be eliminated
because they do not provide confirmation
regarding whether the child aspirated.
59. 1. Abdominal thrusts are not recommended
for children younger than 1 year.
2. Inserting a finger in the child’s mouth may
cause the object to be pushed further
down the airway, making it more difficult
to remove.
3. The Heimlich maneuver should be
performed only on adults.
4. The current recommendation for
infants younger than 1 year is to
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CHAPTER 4 RESPIRATORY DISORDERS
administer five back blows followed by
five chest thrusts.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 3 if familiar
with CPR in infants and children.
60. 1. Teaching the parents signs and symptoms
of foreign body aspiration is important,
but it is a tertiary means of prevention
and will not help the parents prevent the
aspiration.
2. Teaching the parents the therapeutic
management of foreign body aspiration
is important, but it is a tertiary means of
prevention and will not help the parents
prevent the aspiration.
3. Teaching parents the most common
objects aspirated by toddlers will help
them the most. Parents can avoid
having those items in the household
or in locations where toddlers may
have access to them.
4. Teaching the parents the risks associated
with foreign body aspiration is important
but it is a tertiary means of prevention
and will not help the parents prevent the
aspiration.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 4 because
they are all forms of tertiary prevention.
Primary prevention is key to preventing
foreign body aspiration.
61. 1, 3, 4, 5.
1. Children with CF have difficulty
absorbing nutrients because of the
blockage of the pancreatic duct.
Pancreatic enzymes cannot reach the
duodenum to aid in digestion of food.
These children often require up to
150% of the caloric intake of their
peers. The nutritional recommendation for CF patients is high-calorie
and high-protein.
2. A high-fat, high-carbohydrate diet is not
recommended for adequate nutrition.
3. Exercise is effective in helping CF
patients clear secretions.
4. Minimizing pulmonary complications is
essential to a better outcome for CF
patients. Compliance with CPT,
nebulizer treatments, and medications
are all components of minimizing
pulmonary complications.
5. Medication compliance is a necessary
part of maintaining pulmonary and
gastrointestinal function.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because patients are
not placed on high-fat diets.
62. 60 mEq/L.
The definitive diagnosis of CF is made when
a child has a sweat chloride level >60 mEq/L.
A normal chloride level is <40 mEq/L.
TEST-TAKING HINT: The test taker must
have knowledge of tests and normal
values used to identify a diagnosis of CF.
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Neurological
Disorders
5
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Absence seizure
Akinetic seizure
Anencephaly
Anterior fontanel
Apgar
Atonic seizure
Brachycephaly
Brudzinski sign
Cerebellum
Consciousness
Craniosynostosis
Cushing triad
Decerebrate posturing
Decorticate posturing
Delirium
Encephalitis
Epidural hematoma
Epilepsy
Hemiplegia
Hydrocephalus
Kernig sign
Ketogenic diet
Leukemia
Malignancy
Meningitis
Meningocele
Myelomeningocele
Neuroblastoma
Neurogenic bladder
Neurogenic shock
Neurological checks
Nuchal rigidity
Obtunded
Pancytopenia
Posturing
Reye syndrome
Seizure
Spina bifida occulta
Subdural hematoma
Ventricle
Ventriculoperitoneal shunt
ABBREVIATIONS
Cerebral palsy (CP)
Cerebrospinal fluid (CSF)
Diabetes insipidus (DI)
Electroencephalogram (EEG)
Intracranial pressure (ICP)
Motor vehicle accident (MVA)
Pediatric intensive care unit (PICU)
Shaken baby syndrome (SBS)
Ventriculoperitoneal (VP)
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QUESTIONS
1. The nurse is caring for a child who has been in a motor vehicle accident (MVA).
The child falls asleep unless her name is called or she is gently shaken. This state of
consciousness is referred to as:
1. Coma.
2. Delirium.
3. Obtunded.
4. Confusion.
2. The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse
determines that the child is oriented by asking the child to:
1. Name the president of the United States.
2. Identify her parents and state her own name.
3. State her full name and phone number.
4. Identify the current month but not the date.
3. The parents of a child with altered consciousness ask if they can stay during the
morning assessment. Select the nurse’s best response.
1. “Your child is more likely to answer questions and cooperate with any procedures if
you are not present.”
2. “Most children feel more at ease when parents are present, so you are more than
welcome to stay at the bedside.”
3. “It is our policy to ask parents to leave during the first assessment of the shift.”
4. “Many children fear that their parents will be disappointed if they do not do well
with procedures, so we recommend that no parents be present at this time.”
4. The mother of an unconscious child has been calling her name repeatedly and gently
shaking her shoulders in an attempt to wake her up. The nurse notes that the child is
flexing her arms and wrists while bringing her arms closer to the midline of her body.
The child’s mother asks, “What is going on?” Select the nurse’s best response.
1. “I think your daughter hears you, and she is attempting to reach out to you.”
2. “Your child is responding to you; please continue trying to stimulate her.”
3. “It appears that your child is having a seizure.”
4. “Your child is demonstrating a reflex that indicates she is overwhelmed with the
stimulation she is receiving.”
5. Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all
that apply.
1. Sunken anterior fontanel.
2. Complaints of blurred vision.
3. High-pitched cry.
4. Increased appetite.
5. Sleeping more than usual.
6. Which of the following would be included in the plan of care for a hospitalized
newborn following surgical repair of a myelomeningocele. Select all that apply.
1. Skull x-rays.
2. Daily head circumference measurements.
3. MRI scan.
4. Vital signs every 6 hours.
5. Holding to breastfeed.
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7. A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry
vision and now experiences irritability and sleeping more than usual. The parents
ask the nurse what they should do. Select the nurse’s best response.
1. “Give her some acetaminophen, and see if her symptoms improve. If they do not
improve, bring her to the pediatrician’s office.”
2. “It is common for girls to have these symptoms, especially prior to beginning
their menstrual cycle. Give her a few days, and see if she improves.”
3. “You are probably worried that she is having a problem with her shunt. This is
very unlikely as it has been working well for 9 years.”
4. “You should immediately take her to the emergency room as these may be
symptoms of a shunt malfunction.”
8. Which position initially is most beneficial for an infant who has just returned from
having a ventriculoperitoneal (VP) shunt placed?
1. Semi-Fowler in an infant seat.
2. Flat in the crib.
3. Trendelenburg.
4. In the crib with the head elevated to 90 degrees.
9. The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates:
1. Viral meningitis.
2. Bacterial meningitis.
3. No infection, as CSF is usually cloudy.
4. Sepsis.
10. A child is being admitted with the diagnosis of meningitis. Select the procedure the
nurse should do first:
1. Administration of intravenous antibiotics.
2. Administration of maintenance intravenous fluids.
3. Placement of a Foley catheter.
4. Send the spinal fluid and blood samples to the laboratory for cultures.
11. The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the
child is placed in the supine position and flexes his neck, the nurse notes he flexes his
knees and hips. This is referred to as:
1. Brudzinski sign.
2. Cushing triad.
3. Kernig sign.
4. Nuchal rigidity.
12. Select the best room assignment for a newly admitted child with bacterial meningitis.
1. Semiprivate room with a roommate who also has bacterial meningitis.
2. Semiprivate room with a roommate who has bacterial meningitis but has received
intravenous antibiotics for more than 24 hours.
3. Private room that is dark and quiet with minimal stimulation.
4. Private room that is bright and colorful and has developmentally appropriate
activities available.
13. Which order would the nurse question for a child just admitted with the diagnosis of
bacterial meningitis?
1. Maintain isolation precautions until 24 hours after receiving intravenous
antibiotics.
2. Intravenous fluids at 11/2 times regular maintenance.
3. Neurological checks every hour.
4. Administer acetaminophen for temperatures higher than 38°C (100.4°F).
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14. The nurse is caring for a 1-year-old who has just been diagnosed with viral
encephalitis. The parents ask if their child will be admitted to the hospital.
Select the nurse’s best response.
1. “Your child will likely be sent home because encephalitis is usually caused by a
virus and not bacteria.”
2. “Your child will likely be admitted to the pediatric floor for intravenous
antibiotics and observation.”
3. “Your child will likely be admitted to the PICU for close monitoring and
observation.”
4. “Your child will likely be sent home because she is only 1 year old. We see fewer
complications and a shorter disease process in the younger child.”
15. The nurse knows further education is needed about Reye syndrome when a mother
states:
1. “I will have my children immunized against varicella and influenza.”
2. “I will make sure not to give my child any products containing aspirin.”
3. “I will give aspirin to my child to treat a headache.”
4. “Children with Reye syndrome are admitted to the hospital.”
16. A child with Reye syndrome is described in the nurse’s notes as follows:
1200—comatose with sluggish pupils; when stimulated, demonstrates decerebrate
posturing. 1400—unchanged except that now demonstrates decorticate posturing
when stimulated. The nurse concludes that the child’s condition is:
1. Worsening and progressing to a more advanced stage of Reye syndrome.
2. Worsening, and the child may likely experience cardiac and respiratory failure.
3. Improving and progressing to a less advanced stage of Reye syndrome.
4. Improving as the child’s posturing reflexes are similar.
17. To treat a common manifestation of Reye syndrome, which medication would the
nurse expect to have readily available?
1. Lasix.
2. Insulin.
3. Glucose.
4. Morphine.
18. A child diagnosed with meningitis is having a generalized tonic-clonic seizure.
Which should the nurse do first?
1. Administer blow-by oxygen and call for additional help.
2. Reassure the parents that seizures are common in children with meningitis.
3. Call a code and ask the parents to leave the room.
4. Assess the child’s temperature and blood pressure.
19. A child with a seizure disorder has been having episodes during which she drops her
pencil and simply appears to be daydreaming. This is most likely a/an:
1. Absence seizure.
2. Akinetic seizure.
3. Non-epileptic seizure.
4. Simple spasm seizure.
20. A preschooler has been having periods during which he suddenly falls and appears to
be weak for a short time after the event. The preschool teacher asks what she should
do. Select the nurse’s best response.
1. “Have the parents follow up with his pediatrician as this is likely an atonic
seizure.”
2. “Find out if there have been any new stressors in his life, as it could be
attention-seeking behavior.”
3. “Have the parents follow up with his pediatrician as this is likely an absence
seizure.”
4. “The preschool years are a time of rapid growth, and many children appear
clumsy. It would be best to watch him, and see if it continues.”
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21. The diet that produces anticonvulsant effects from ketosis consists of:
1. High-fat and low-carbohydrate foods.
2. High-fat and high-carbohydrate foods.
3. Low-fat and low-carbohydrate foods.
4. Low-fat and high-carbohydrate foods.
22. Which medication should the nurse anticipate administering first to a child in status
epilepticus?
1. Establish an intravenous line, and administer intravenous lorazepam.
2. Administer rectal diazepam.
3. Administer an oral glucose gel to the side of the child’s mouth.
4. Administer oral diazepam.
23. The nurse is providing discharge teaching to the parents of a toddler who
experienced a febrile seizure. The nurse knows clarification is needed when the
mother says:
1. “My child will likely have another seizure.”
2. “My child’s 7-year-old brother is also at high risk for a febrile seizure.”
3. “I’ll give my child acetaminophen when ill to prevent the fever from rising too
high too rapidly.”
4. “Most children with febrile seizures do not require seizure medicine.”
24. A child recently diagnosed with epilepsy is being evaluated for anticonvulsant
medication therapy. The child will likely be placed on which type of regimen?
1. Two to three oral anticonvulsant medications so that dosing can be low and side
effects minimized.
2. One oral anticonvulsant medication to observe effectiveness and minimize side
effects.
3. One rectal gel to be administered in the event of a seizure.
4. A combination of oral and intravenous anticonvulsant medications to ensure
compliance.
25. Which activity should an adolescent just diagnosed with epilepsy avoid?
1. Swimming, even with a friend.
2. Being in a car at night.
3. Participating in any strenuous activities.
4. Returning to school right away.
26. Which is the best action for the nurse to take during a child’s seizure?
1. Administer the child’s rescue dose of oral Valium (diazepam).
2. Loosen the child’s clothing, and call for help.
3. Place a tongue blade in the child’s mouth to prevent aspiration.
4. Carry the child to the infirmary to call 911 and start an intravenous line.
27. Brain damage in a child who sustained a closed-head injury can be caused by which
factor?
1. Increased perfusion to the brain and increased metabolic needs of the brain.
2. Decreased perfusion to the brain and decreased metabolic needs of the brain.
3. Increased perfusion to the brain and decreased metabolic needs of the brain.
4. Decreased perfusion of the brain and increased metabolic needs of the brain.
28. A child fell off his bike and sustained a closed-head injury. The child is currently
awake and alert, but his mother states that he “passed out” for approximately
2 minutes. The mother appears highly anxious and is very tearful. The child was
not wearing a helmet. Which is a priority for the triage nurse to say at this time?
1. “Was anyone else injured in the accident?”
2. “Tell me more about the accident.”
3. “Did he vomit, have a seizure, or display any other behavior that was unusual
when he woke up?”
4. “Why was he not wearing a helmet?”
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29. The nurse is caring for an unconscious 6-year-old who has had a severe closed-head
injury and notes the following changes: heart rate has dropped from 120 to 55, blood
pressure has increased from 110/44 to 195/62, and respirations are becoming more
irregular. Which should the nurse do first after calling the physician?
1. Call for additional help, and prepare to administer mannitol.
2. Continue to monitor the patient’s vital signs, and prepare to administer a bolus of
isotonic fluids.
3. Call for additional help, and prepare to administer an antihypertensive.
4. Continue to monitor the patient, and administer supplemental oxygen.
30. A child in the PICU with a head injury is comatose and unresponsive. The parent
asks if he needs pain medication. Select the nurse’s best response.
1. “Pain medication is not necessary as he is unresponsive and cannot feel pain.”
2. “Pain medication may interfere with his ability to respond and may mask any
signs of improvement.”
3. “Pain medication is necessary to make him comfortable.”
4. “Pain medication is necessary for comfort, but we use it cautiously as it increases
the demand for oxygen.”
31. The nurse is caring for a child with a skull fracture who is unconscious and has
severely increased intracranial pressure (ICP). The nurse notes the child’s
temperature to be 104°F (40°C). Which should the nurse do first?
1. Place a cooling blanket on the child.
2. Administer Tylenol (acetaminophen) via nasogastric tube.
3. Administer Tylenol (acetaminophen) rectally.
4. Place ice packs in the child’s axillary areas.
32. The nurse is caring for an adolescent who remains unconscious 24 hours after
sustaining a closed-head injury in a motor vehicle accident (MVA). She responds to
deep, painful stimulation with decorticate posturing and has an intracranial monitor
that shows periodic increased ICP. All other vital signs remain stable. Select the most
appropriate nursing action.
1. Encourage the teen’s peers to visit and talk to her about school and other
pertinent events.
2. Encourage the teen’s parents to hold her hand and speak loudly to her in an
attempt to help her regain consciousness.
3. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively
environment during the day and dark quiet environment at night.
4. Attempt to keep the environment dark and quiet, and encourage minimal stimulation.
33. A 2-month-old infant is brought to the emergency room after experiencing a seizure.
The infant appears lethargic with very irregular respirations and periods of apnea. The
parents report the baby is no longer interested in feeding and before the seizure, rolled
off the couch. What additional testing should the nurse immediately prepare for?
1. Computed tomography (CT) scan of the head and dilation of the eyes.
2. Computed tomography (CT) scan of the head and electroencephalogram (EEG).
3. X-rays of the head.
4. X-rays of all long bones.
34. The nurse knows that young infants are at risk for injury from shaken baby syndrome
(SBS) because:
1. The anterior fontanel is open.
2. They have insufficient musculoskeletal support and a disproportionate
head-to-body ratio.
3. They have an immature vascular system with veins and arteries that are more
superficial.
4. The nurse knows there is immature myelination of the nervous system in a young
infant.
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35. An infant is born with a sac protruding through the spine, containing cerebrospinal fluid
(CSF), a portion of the meninges, and nerve roots. This condition is referred to as:
1. Meningocele.
2. Myelomeningocele.
3. Spina bifida occulta.
4. Anencephaly.
36. Which is the nurse’s best response to the parents of a neonate with a meningocele
who ask what can they expect?
1. “After initial surgery to close the defect, most children experience no neurological
dysfunction.”
2. “Surgery to close the sac will be postponed until the infant has grown and has
enough skin to form a graft.”
3. “After the initial surgery to close the defect, the child will likely have motor and
sensory deficits.”
4. “After the initial surgery to close the defect, the child will likely have future
problems with urinary and bowel continence.”
37. The nurse is caring for an infant with a myelomeningocele. The parents ask the
nurse why the nurse keeps measuring the baby’s head circumference. Select the
nurse’s best response:
1. “Babies’ heads are measured to ensure growth is on track.”
2. “Babies with a myelomeningocele are at risk for hydrocephalus, which shows up
as an increase in head size.”
3. “Because your baby has an opening on the spinal cord, your infant is at risk for
meningitis, which can show up as an increase in head size.”
4. “Many infants with myelomeningocele have microcephaly, which can show up as a
decrease in head size.”
38. A parent of a newborn diagnosed with myelomeningocele asks what is a common
long-term complication? The nurse’s best response is:
1. Learning disabilities.
2. Urinary tract infections.
3. Hydrocephalus.
4. Decubitus ulcers and skin breakdown.
39. Which is included in the plan of care for a newborn who has a myelomeningocele?
1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly
begin oral gastric feeds to prevent the development of necrotizing enterocolitis.
2. Place the child in the prone position with a sterile dry dressing over the defect.
Begin intravenous fluids to prevent dehydration.
3. Place the child in the prone position with a sterile moist dressing over the defect.
Slowly begin oral gastric feeds to prevent the development of necrotizing
enterocolitis.
4. Place the child in the prone position with a sterile moist dressing over the defect.
Begin intravenous fluids to prevent dehydration.
40. The parents of a 12-month-old with a neurogenic bladder ask the nurse if their child
will always have to be catheterized. Select the nurse’s best response.
1. “Your child will never feel when her bladder is full, so she will always have to be
catheterized. Because she is female, she will always need assistance.”
2. “As your child ages, she will likely be able to sense when her bladder is full and
will be able to empty it on her own.”
3. “Although your child will not be able to feel when her bladder is full, she can
learn to urinate every 4 to 6 hours and therefore not require catheterizations.”
4. “Your child will never be able to completely empty her bladder spontaneously,
but there are other options to traditional catheterization. An opening can be made
surgically through the abdomen allowing you and her to place a catheter into
the opening.”
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41. Which does the nurse include in a child with myelomeningocele postoperative plan
of care following ligament release?
1. Encourage the child to resume a regular diet, beginning slowly with bland foods
that are easily digested, such as bananas.
2. Encourage the child to blow balloons to increase deep breathing and avoid
postoperative pneumonia.
3. Assist the child to change positions to avoid skin breakdown.
4. Provide education on dietary requirements to prevent obesity and skin breakdown.
42. A 6-month-old infant was just diagnosed with craniosynostosis. The infant’s father
asks the nurse for more information about reconstructive surgery. Select the nurse’s
best response.
1. “The surgery is done for cosmetic reasons and is without many complications.”
2. “The surgery is important to allow the brain to grow properly. Although most
children do well, serious complications can occur, so your child will be closely
observed in the intensive care unit.”
3. “The surgery is important to allow the brain to grow properly. Most surgeons
wait until the child is 3 years old to minimize potential complications.”
4. “The surgery is mainly done for cosmetic reasons, and most surgeons wait until
the child is 3 years old as the head has finished growing at that time.”
43. A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is
providing teaching about the use of a helmet for his therapy. Which statement
indicates that the parents understand the education?
1. “We will keep the helmet on him when he is awake and remove it only for
bathing and sleeping.”
2. “He will start wearing the helmet when he is closer to 9 months, as he will be
more upright and mobile.”
3. “He will wear the helmet 23 hours every day.”
4. “Most children need to wear the helmet for 6 to 12 months.”
44. The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the
incidence of CP has:
1. Increased.
2. Decreased.
3. Remained the same.
4. Has decreased due to early misdiagnosis.
45. Which child is at increased risk for cerebral palsy (CP)?
1. Infant born at 34 weeks with an Apgar score of 6 at 5 minutes.
2. 17-day-old infant with group B streptococcus meningitis.
3. 24-month-old child who has experienced a febrile seizure.
4. 5-year-old with a closed-head injury after falling off a bike.
46. Which child requires continued follow-up because of behaviors suspicious of cerebral
palsy (CP)?
1. 1-month-old who demonstrates the startle reflex when a loud noise is heard.
2. 6-month-old who always reaches for toys with the right hand.
3. 14-month-old who has not begun to walk.
4. 2-year-old who has not yet achieved bladder control during waking hours.
47. The parents of a child with meningitis and multiple seizures ask if the child will
likely develop cerebral palsy (CP). Select the nurse’s best response.
1. “When your child is stable, she’ll undergo computed tomography (CT) and magnetic
resolution imaging (MRI). The physicians will be able to let you know if she has CP.”
2. “Most children do not develop CP at this late age.”
3. “Your child will be closely monitored after discharge, and a developmental
specialist will be able to make the diagnosis.”
4. “Most children who have had complications following meningitis develop some
amount of CP.”
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48. The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP)
due to extreme low birth weight and prematurity. His parents ask why a speech
therapist is involved in his care. Select the nurse’s best response.
1. “Your child is likely to have speech problems because of his early birth. Involving the
speech therapist now will ensure vocalization at a developmentally appropriate age.”
2. “The speech therapist will help with tongue and jaw movements to assist with
babbling.”
3. “The speech therapist will help with tongue and jaw movements to assist with
feeding.”
4. “Many members of the health-care team are involved in your child’s care so that
we will know if there are any unmet needs.”
49. The nurse prepares to administer baclofen to a child with cerebral palsy (CP) who
just had her hamstrings surgically released. The child’s parents ask what the
medication is for. Select the nurse’s best response.
1. “It is a medication that will help decrease the pain from her surgery.”
2. “It is a medication that will prevent her from having seizures.”
3. “It is a medication that will help control her spasms.”
4. “It is a medication that will help with bladder control.”
50. A child with cerebral palsy (CP) has been fitted for braces and is beginning physical
therapy to assist with ambulation. The parents ask why he needs the braces when he
was crawling without any assistive devices. Select the nurse’s best response.
1. “The CP has progressed, and he now needs more assistance to ambulate.”
2. “As your child grows, different muscle groups may need more assistance.”
3. “Most children with CP need braces to help with ambulation.”
4. “We have found that when children with CP use braces, they are less likely to fall.”
51. The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should
teach their child sign language because he has not begun to vocalize. The nurse bases
the response on the knowledge that sign language:
1. May be a very beneficial way to help children with CP communicate.
2. May cause confusion and further delay vocalization.
3. Is difficult to learn for most children with CP.
4. Is beneficial to learn, but it would be best to wait until the child is older
52. The parents of a child with cerebral palsy (CP) are learning how to feed their child
and avoid aspiration. The nurse would question which of the following when
reviewing the teaching plan?
1. Place the food on the tip of the tongue.
2. Place the child in an upright position during feedings.
3. Feed the child soft and blended foods.
4. Feed the child slowly.
53. The nurse is caring for a child with cerebral palsy (CP) whose weight is in the fifth
percentile and who has been hospitalized for aspiration pneumonia. His parents are
anxious and state that they do not want a G-tube placed. Which would be the nurse’s
best response?
1. “A G-tube will help your son gain weight and reduce his risk for future
hospitalizations due to pneumonia.”
2. “G-tubes are very easy to care for and will make feeding time easier for your family.”
3. “Are you concerned that you will not be able to care for his G-tube?”
4. “Tell me your thoughts about G-tubes.”
54. The parent of an infant diagnosed with a neuroblastoma asks the nurse what the
prognosis is. The nurse’s best response is:
1. Excellent, as a neuroblastoma is always cured.
2. Excellent, as infants with a neuroblastoma have the best prognosis.
3. Poor, as infants with a neuroblastoma rarely survive.
4. Variable, depending on the site of origin.
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55. Which should be included in the plan of care for a child who has a neuroblastoma
with metastasis to the bone marrow and pancytopenia?
1. Administer red blood cells.
2. Limit school attendance to less than 4 hours daily.
3. Administer Coumadin.
4. Encourage a diet high in fresh fruits and vegetables.
56. The parent of a child with neuroblastoma asks the nurse what the typical signs and
symptoms are at first. Select the nurse’s best answer.
1. “Most children complain of abdominal fullness and difficulty urinating.”
2. “Many children in the early stages of a neuroblastoma have joint pain and walk
with a limp.”
3. “The signs and symptoms vary depending on where the tumor is located, but
typical symptoms include weight loss, abdominal distention, and fatigue.”
4. “The signs and symptoms are fairly consistent regardless of the location of the
tumor. They include fatigue, hunger, weight gain, and abdominal fullness.”
57. Which child would likely have experienced a delay in the diagnosis of a brain tumor?
1. 3-month-old, as signs and symptoms would not have been readily apparent.
2. 5-month-old, as signs and symptoms would not have been readily suspected.
3. School-age child, as signs and symptoms could have been misinterpreted.
4. Adolescent, as signs and symptoms could have been ignored and denied.
58. A child has been diagnosed with a midline brain tumor. In addition to showing signs
of increased intracranial pressure (ICP), she has been voiding large amounts of very
dilute urine. Which medication does the nurse expect to administer?
1. Mannitol.
2. Vasopressin.
3. Lasix.
4. Dopamine.
59. The nurse is caring for a child receiving radiation therapy for a brain tumor. The
parents ask if their child will likely have any learning disabilities. Select the nurse’s
best answer.
1. “All children who receive radiation have some amount of learning disability. As
long as they receive extra tutoring, they usually do well in school.”
2. “Because your child is so young, she will likely do well and have no problems in
the future.”
3. “Response varies with each child, but younger children who receive radiation tend
to have some amount of learning disability later in life.”
4. “Response varies with each child, but younger children who receive radiation tend
to have fewer problems later in life than older children.”
60. A child involved in a motor vehicle accident (MVA) is currently on a backboard with
a cervical collar in place. The child is diagnosed with a cervical fracture. Which
would the nurse expect to find in the child’s plan of care?
1. Remove the cervical collar, keep the backboard in place, and administer high-dose
methylprednisolone.
2. Continue with all forms of spinal stabilization, and administer high-dose
methylprednisolone and ranitidine.
3. Remove the backboard and cervical collar, and prepare for halo traction placement.
4. Remove the cervical collar and backboard, place the child on spinal precautions,
and administer high-dose methylprednisolone and ranitidine.
61. Which has the potential to alter a child’s level of consciousness? Select all that apply.
1. Metabolic disorders.
2. Trauma.
3. Hypoxic episode.
4. Dehydration.
5. Endocrine disorders.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Coma describes a state of consciousness in
which the child is not responsive to any
stimulation, including painful stimulation.
2. Delirium describes a state of consciousness
in which the child is extremely confused and
anxious.
3. Obtunded describes a state of consciousness in which the child has a
limited response to the environment
and can be aroused by verbal or tactile
stimulation.
4. Confusion describes a state of consciousness
in which the child is not oriented to person,
place, and time.
TEST-TAKING HINT: The test taker needs to
be familiar with terms describing states of
consciousness.
2. 1. Most 3-year-olds are not capable of naming
the president.
2. Asking the 3-year-old to identify her
parents and state her name is a
developmentally appropriate way
to assess orientation.
3. Many 3-year-olds are not familiar with their
phone numbers or may not be able to share
this information during a stressful time,
such as hospitalization.
4. Many 3-year-olds do not know the current
month.
TEST-TAKING HINT: The test taker
needs to be familiar with the concept of
consciousness and applying normal
developmental-specific age groups.
3. 1. School-age children feel more comfortable
when parents are present and are more likely
to cooperate with a neurological assessment.
2. Parents should be encouraged to remain
with their child for mutual comfort.
3. Describing a policy is not sufficient and does
not give the parents enough information.
4. School-age children feel more comfortable
when parents are present and are more
likely to cooperate with a neurological
assessment.
TEST-TAKING HINT: The test taker needs to
be familiar with growth and development
of children and applying theories to specific
clinical situations.
4. 1. The child is demonstrating a reflex called
posturing. The parent should not be given
any false hope that the child is responding
at a higher level than is truly occurring.
2. The posturing reflex often indicates irritability, and the child should not continue
to receive stimulation.
3. Posturing is a reflex, not a seizure.
4. Posturing is a reflex that often indicates
that the child is receiving too much
stimulation.
TEST-TAKING HINT: The test taker needs
to be familiar with caring for the comatose
child and what causes posturing.
5. 3, 5.
1. The anterior fontanel is usually raised and
bulging in infants with increased ICP.
2. The infant is not able to comprehend
blurred vision or make any statements.
3. A high-pitched cry is often indicative of
increased ICP in infants.
4. The infant with increased ICP usually has a
poor appetite and does not feed well.
5. The infant may be sleeping more than
usual due to increased ICP.
TEST-TAKING HINT: The test taker needs
to be familiar with hydrocephalus and how
increased ICP is manifested in infants.
Answer 2 can be eliminated because an
infant cannot specifically verbalize.
6. 2, 3.
1. Diagnostic tests include MRI scan, CT
scan, ultrasound, and myelography. These
tests give much more needed information
than do skull x-rays.
2. Daily head circumference measurements
are done to assess for hydrocephalus.
3. Diagnostic tests include MRI scan, CT
scan, ultrasound, and myelography.
4. Vital signs should be taken at least every
4 hours.
5. Infants with repaired myelomeningocele
are kept prone to prevent pressure on the
surgical site.
TEST-TAKING HINT: The test taker needs
to be familiar with post-operative care for
infants with myelomeningocele.
7. 1. These are symptoms of a shunt malfunction
and should be evaluated immediately.
2. Although these symptoms may be associated
with the start of a girl’s menstrual cycle, they
are symptoms of a shunt malfunction and
require immediate evaluation.
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3. A shunt can malfunction at any point
and should be evaluated when signs of
increased ICP are evident.
4. These are symptoms of a shunt
malfunction and should be evaluated
immediately.
TEST-TAKING HINT: The test taker should
recognize these symptoms as signs of a
shunt malfunction and can eliminate
answers 1, 2, and 3 because they do not
address the situation as an emergency.
8. 1. A semi-Fowler position in an infant seat
may allow the ventricles to drain too rapidly in the immediate postoperative period.
2. Flat in the crib is the position usually
used initially, with the angle gradually
increasing as the child tolerates.
3. The Trendelenburg position is not used
immediately after ventriculoperitoneal
shunt placement because it would
increase ICP
4. The head elevated to 90 degrees will allow
the ventricle of the brain to drain too
quickly.
TEST-TAKING HINT: The test taker should
note the word “initially” and consider
why the position would be immediately
beneficial. Answer 3 can be eliminated
because that particular position could
increase ICP.
priority, as antibiotics should not be
started before the samples have been
obtained and sent for culturing.
11. 1. Brudzinski sign occurs when the child
responds to a flexed neck with an involuntary flexion of the hips and/or knees.
2. Cushing triad is a sign of increased ICP
and is manifested with an increase in
systolic blood pressure, decreased heart
rate, and irregular respirations.
3. Kernig sign occurs when there is
resistance or pain in response to raising
the child’s flexed leg.
4. Nuchal rigidity occurs when there is a
resistance to neck flexion.
TEST-TAKING HINT: The test taker should
be familiar with terms used to describe
meningeal irritation.
9. 1. The CSF in viral meningitis is usually clear.
2. The CSF in bacterial meningitis is
usually cloudy.
3. The CSF in healthy children is usually clear.
4. Sepsis is an infection of the bloodstream.
TEST-TAKING HINT: The test taker can
eliminate answer 4 because an infection of
the bloodstream would not be detected in
the CSF.
12. 1. The child with bacterial meningitis should
be placed in a private room isolated from
all other patients. Bacterial meningitis is
caused by many pathogens, and patients
should be isolated from each other.
2. The child with bacterial meningitis should
be placed in a private room isolated from
all other patients. Bacterial meningitis is
caused by many pathogens, and patients
should be isolated from each other.
3. A quiet private room with minimal
stimulation is ideal as the child with
meningitis should be in a quiet environment to avoid cerebral irritation.
4. A bright room with developmental activities may cause irritation and increase ICP.
TEST-TAKING HINT: The test taker should
consider what contributes to cerebral irritation and should not be influenced by the
developmental requirements of a healthy
child.
10. 1. Administration of intravenous antibiotics
should not be started until after all
cultures have been obtained.
2. Administration of maintenance IV fluids
can wait until after the cultures have been
obtained.
3. Placement of a Foley catheter is not a
priority procedure.
4. Cultures of spinal fluid and blood should
be obtained, followed by administration
of intravenous antibiotics.
TEST-TAKING HINT: The test taker needs to
think about priority of care. Answer 3 can
be immediately eliminated, as it is not a
priority. Answer 4 should be considered a
13. 1. Isolation precautions must be maintained
for at least the first 24 hours of intravenous
antibiotic therapy.
2. Intravenous fluids at 11/2 times regular
maintenance could cause fluid overload
and lead to increased ICP.
3. Neurological checks are usually made at
least every hour.
4. Acetaminophen is usually administered
when the child has a fever, as increased
temperature can lead to increased ICP.
TEST-TAKING HINT: The test taker should
consider the answers and eliminate those
that may increase ICP. Intravenous fluids
are often given at less than maintenance
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CHAPTER 5 NEUROLOGICAL DISORDERS
unless the child is hemodynamically
unstable.
14. 1. Although encephalitis is usually caused by a
viral infection, the child is usually admitted
for close observation.
2. Intravenous antibiotics are not given to
the child with viral encephalitis.
3. The young child with encephalitis
should be admitted to a PICU where
close observation and monitoring are
available. The child should be observed
for signs of increased ICP and for
cardiac and respiratory compromise.
4. The child would not be discharged as
observation for complications is necessary.
As a general rule, younger children tend
to have more complications and require a
PICU admission.
TEST-TAKING HINT: The test taker
should be familiar with the diagnosis and
treatment of encephalitis. The test taker
should not be influenced by the word
“viral” but should realize that the
sequelae of encephalitis require close
monitoring in an ICU environment.
15. 1. Having a child immunized helps prevent
viral illnesses from occurring, thereby
decreasing the likelihood of Reye syndrome.
2. The administration of aspirin or products
containing aspirin has been associated
with the development of Reye syndrome.
3. The administration of aspirin or
products containing aspirin has been
associated with the development of
Reye syndrome. A headache can be
the first sign of a viral illness followed
by other symptoms. It is best not to
use aspirin or aspirin-containing
products in children.
4. Children with Reye syndrome are always
admitted to the hospital as there is a
strong possibility for complications and
rapid deterioration.
TEST-TAKING HINT: The test taker should
be aware that aspirin administration in
children with viral infections has been
linked to Reye syndrome.
16. 1. Decorticate posturing is seen with a less
advanced stage of Reye syndrome and
likely indicates that the child’s condition
is improving.
2. The child’s condition is improving; therefore, cardiac and respiratory failure is less
likely.
3. Progressing from decerebrate to decorticate posturing usually indicates an
improvement in the child’s condition.
4. Decorticate posturing is associated with inflammation above the brain stem, whereas
decerebrate posturing is associated with
inflammation in the brain stem.
TEST-TAKING HINT: The test taker needs to
be familiar with posturing reflexes and
their significance.
17. 1. A common manifestation is increased ICP,
which is treated with an osmotic diuretic.
Lasix is a loop diuretic.
2. A common manifestation is hypoglycemia.
Insulin does not treat hypoglycemia, but
decreases the blood sugar instead.
3. A common manifestation is hypoglycemia, which is treated with the
administration of intravenous glucose.
4. Morphine is a narcotic used for pain relief.
It should be used with caution as it can
lead to respiratory depression.
TEST-TAKING HINT: The test taker needs to
be aware that increased ICP is a very
common manifestation of Reye syndrome
and can therefore eliminate any answers
that do not treat increased ICP. The test
taker can also eliminate answers 2 and 4
because they do not treat hypoglycemia,
which is another common manifestation
of Reye syndrome.
18. 1. The child experiencing a seizure usually
requires more oxygen as the seizure
increases the body’s metabolic rate and
demand for oxygen. The seizure may also
affect the child’s airway, causing the child
to be hypoxic. It is always appropriate
to give the child blow-by oxygen
immediately. The nurse should remain
with the child and call for additional help.
2. It is important to reassure the parents, but
giving the child oxygen and calling for
additional support is the priority of care.
3. It is not necessary to call a code unless the
child experiences a cardiac or respiratory
arrest. Research indicates that encouraging
parents to remain with the child in
emergency situations benefits both the
child and family.
4. It is important to monitor and observe
the child during a seizure, but it is very
difficult to obtain a blood pressure from a
seizing child. The priority of care involves
administering oxygen and calling for
additional help.
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TEST-TAKING HINT: The test taker needs to
prioritize care and choose answer 1
because it will help maintain the airway.
Answer 3 could immediately be eliminated
because the child is having a seizure, not a
cardiac arrest.
19. 1. Absence seizures occur frequently and
last less than 30 seconds. The child
experiences a brief loss of consciousness
during which she may have a change in
activity. These children rarely fall, but
they may drop an object. The condition
is often confused with daydreaming.
2. Akinetic seizures occur when the young
child experiences a brief loss of consciousness and postural tone and falls to the
ground. The child quickly regains
consciousness.
3. A non-epileptic seizure is a seizure that
occurs secondary to another disorder, such
as a fever or increased ICP.
4. A simple spasm seizure is not a diagnosis.
TEST-TAKING HINT: “Daydreaming” is the
classic description of an absence seizure.
20. 1. An atonic seizure is characterized by a
loss of muscular tone, whereby the
child may fall to the ground.
2. It is important to evaluate the child for life
stressors, but suspected seizure activity
needs immediate evaluation.
3. An absence seizure is characterized by a
change in activity whereby the child
appears to be daydreaming or staring
straight ahead. The child usually continues
basic simple movements but loses an
awareness of surroundings.
4. The preschool years are a not a time of
rapid growth. Many children in this age
group appear clumsy, but suspected seizure
activity needs immediate evaluation.
TEST-TAKING HINT: The test taker should
recognize the description as seizure activity
and, therefore, could immediately eliminate
answers 3 and 4.
21. 1. High fat and low carbohydrates are the
components of the ketogenic diet.
2. High fat and high carbohydrates are the
components of the ketogenic diet.
3. Low fat and low carbohydrates are the
components of the ketogenic diet.
4. Low fat and high carbohydrates are the
components of the ketogenic diet.
TEST-TAKING HINT: The test taker needs
to be familiar with the components of a
ketogenic diet.
22. 1. It is very difficult and time consuming to
establish an intravenous line on a child
who is experiencing a generalized seizure.
Rectal diazepam is first administered in an
attempt to stop the seizure long enough to
establish a line, and then medication is
administered intravenously.
2. Rectal diazepam is first administered
in an attempt to stop the seizure long
enough to establish an IV, and then
IV medication is administered.
3. Although the child may become hypoglycemic due to increased metabolic
demands, stopping the seizure with
rectal diazepam is the first priority.
Medication is not placed in the mouth
of a child experiencing a generalized
seizure as it increases the risk of injury
and aspiration.
4. Stopping the seizure with rectal diazepam
takes priority. Nothing should be administered orally to a patient who is unconscious.
TEST-TAKING HINT: The test taker needs to
consider the current situation and the
level of difficulty in establishing intravenous access in a child experiencing a
generalized seizure.
23. 1. Children who experience a febrile seizure
are likely to experience another febrile
seizure.
2. Most children over the age of 5 years
do not have febrile seizures.
3. Antipyretics are administered to prevent
the child’s temperature from rising too
rapidly.
4. Most children are not prescribed anticonvulsant medication after experiencing a
febrile seizure.
TEST-TAKING HINT: There is an increased
risk in siblings, but the 7-year-old child is
above the usual age of febrile seizures.
24. 1. Although many children with epilepsy
require more than one medication to
achieve seizure control, it is recommended
that only one medication be started at a
time so that the child’s reaction to the
specific medication can be observed.
2. One medication is the preferred way
to achieve seizure control. The child
is monitored for side effects and drug
levels.
3. Rectal gels are used to stop a seizure once
it has begun; they are not used to prevent
seizures.
4. The route of choice for the prevention
of seizures is oral. There is no reason to
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assume that compliance will be an issue
prior to beginning anticonvulsant therapy.
TEST-TAKING HINT: The test taker should
eliminate answer 4 because IV medications
are not included in the initial home
medication regimen.
25. 1. Swimming does not need to be avoided as
long as there is someone else present to
call for help in the event of an emergency.
2. The rhythmic reflection of other car
lights can trigger a seizure in some
children.
3. There is no reason to avoid strenuous
activity.
4. It is important for adolescents to be with
their peers in order to reach developmental
milestones.
TEST-TAKING HINT: The test taker should
consider the answers that can lead to a
seizure. Answer 2 is the only answer that
includes a common trigger.
26. 1. Nothing should be placed in the child’s
mouth as he is at risk for aspiration.
Rescue Valium is usually administered
rectally.
2. The nurse should remain with the
child and observe the seizure. The
child should be protected from his
environment, and clothing should be
loosened.
3. A tongue blade should never be placed in
the child’s mouth, as it can cause injury or
increase the risk of aspiration.
4. The nurse should remain with the child
and call for help. A child can be injured if
carried during a seizure.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 3 because nothing
should ever be placed in the mouth of a
child having a seizure.
27. 1. The child who has a closed-head injury
has decreased perfusion to the brain and
increased metabolic needs that lead to
ischemia and brain damage.
2. The child who has a closed-head injury
has decreased perfusion to the brain and
increased metabolic needs that lead to
ischemia and brain damage.
3. The child who has a closed-head injury
has decreased perfusion to the brain and
increased metabolic needs that lead to
ischemia and brain damage.
4. Decreased perfusion of the brain and
increased metabolic needs of the brain.
TEST-TAKING HINT: The test taker needs to
be familiar with the mechanics of a head
injury.
28. 1. It is not a priority of care to find out if
anyone else was injured.
2. Although open-ended questions are important, the nurse needs specific information,
and the anxious parent may need to be
guided during triage assessment.
3. Asking specific questions will give the
nurse the information needed to determine the level of care for the child.
4. Although it is important to provide safety
education, this information should be given
in a nonjudgmental manner at a point when
the parents and child are less stressed.
TEST-TAKING HINT: The test taker needs to
consider the role of a triage nurse and to
obtain specific information quickly.
Answer 4 can be eliminated because it
implies judgment and does not help the
current situation.
29. 1. Cushing triad is characterized by a
decrease in heart rate, an increase in
blood pressure, and changes in respirations. The triad is associated with
severely increased ICP. Mannitol is
an osmotic diuretic that helps decrease
the increased ICP.
2. The child’s vital signs need to be monitored, but a fluid bolus will increase the circulating volume and lead to an increase in
the child’s ICP. Fluid boluses are necessary
in cases of shock but must be administered
carefully and the child closely observed.
3. An antihypertensive will not help decrease
the ICP.
4. The child will benefit from supplemental
oxygen, but it will not help decrease
the ICP.
TEST-TAKING HINT: The test taker should
recognize the signs of Cushing triad.
If not recognized, the child’s condition
should be seen as deteriorating and emergent. Answers 2 and 4 can be eliminated
because they are only partially correct.
30. 1. Even if the child is unresponsive, the child
can still feel pain.
2. If pain medication is administered cautiously, the child can still be monitored,
and signs of improvement will be evident.
3. Pain medication promotes comfort and
ultimately decreases ICP.
4. Pain medication decreases the demand for
oxygen.
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TEST-TAKING HINT: The test taker needs to
consider the presence and significance of
pain in the unresponsive child. Answer 1
can be immediately eliminated because
the unresponsive child does feel pain.
31. 1. A cooling blanket will help cool the child
quickly and at a controlled temperature.
2. Tylenol should be administered after the
cooling blanket has been applied. Tylenol
is an effective medication, but a cooling
blanket will begin to be effective before
the medication is absorbed.
3. Tylenol should be administered after the
cooling blanket has been applied. Tylenol
is an effective medication, but a cooling
blanket will begin to be effective before
the medication is absorbed.
4. Ice packs will cause the child to shiver,
which will increase oxygen consumption
and possibly increase ICP. Shivering can
also cause the child to experience a
rebound increase in temperature.
TEST-TAKING HINT: The test taker should
consider the cause of the increased
temperature and how to cool the child
quickly. Answer 4 should be eliminated
because ice packs are no longer recommended to treat increased temperatures.
32. 1. Although peers play an important role in
the adolescent’s development, this particular patient is at risk for increased ICP and
should have decreased stimulation.
2. Loud talking may cause the child’s ICP to
increase.
3. A bright, lively environment may lead to
increased ICP.
4. A dark, quiet environment and minimal
stimulation will decrease oxygen
consumption and ICP.
TEST-TAKING HINT: The test taker should
consider the causes of ICP and select
answers that will not increase ICP.
Answers 1, 2, and 3 cause an increase
in ICP and should be eliminated.
33. 1. A computed tomography scan of the
head will reveal trauma. Dilating the
eyes is performed to check for retinal
hemorrhages that are seen in an infant
who has experienced SBS.
2. An EEG is not usually done as a priority
test in an infant displaying symptoms of
SBS.
3. X-rays of the head will show fractures
but CT and pupil examinations are the
priority for this child.
4. X-rays of all long bones may be performed
to rule out any old or new fractures, but
CT and pupil examinations are the
priority for this child.
TEST-TAKING HINT: The test taker should
consider child abuse (SBS) as the story
does not match the injury. The pupils are
always dilated to rule out SBS.
34. 1. An open anterior fontanel allows for
swelling, therefore decreasing the risk
of injury.
2. Insufficient musculoskeletal support
and a disproportionate head size place
the infant at risk because the head
cannot be supported during a shaking
episode.
3. Superficial veins and arteries do not place
the infant at a higher risk for injury.
4. Although the myelination is immature, the
immature musculoskeletal support places
the infant at risk.
TEST-TAKING HINT: Answer 3 should be
eliminated because superficial vessels do
not lead to SBS.
35. 1. Meningocele is a sac that contains a portion
of the meninges, and cerebrospinal fluid.
2. A myelomeningocele is a sac that
contains a portion of the meninges,
the CSF, and the nerve roots.
3. Spina bifida occulta is the mildest form
of spina bifida in which one or more vertebrae are malformed. The child usually
has no symptoms and in most cases no
one knows there is a spinal defect.
4. Anencephaly is a neural tube defect in
which the bones of the skull and head do
not form correctly. Infants are missing
large parts of their brain and skull.
TEST-TAKING HINT: The test taker
would need to know the definition of
myelomeningocele to answer this question.
36. 1. Because a meningocele does not contain any nerve endings, most children
experience no neurological problems
after surgical correction.
2. Corrective surgery is done as soon as
possible to minimize the risk of infection.
3. Because a meningocele does not contain
any nerve endings, most children experience no neurological problems after
surgical correction.
4. Because a meningocele does not contain
any nerve endings, most children experience
no neurological problems after surgical
correction.
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TEST-TAKING HINT: The test taker should
consider the risks of infection and immediately eliminate answer 2 because the
surgery is not postponed but performed
as soon as possible.
37. 1. Although it is important to measure the
head circumference of all babies, children
with myelomeningocele are at increased risk
for hydrocephalus, which can be manifested
with an increase in head circumference.
2. Children with myelomeningocele are at
increased risk for hydrocephalus, which
can be manifested with an increase in
head circumference.
3. Although a defect in the spine can be a
portal of entry for infection, children with
myelomeningocele often have hydrocephalus as well.
4. Children with myelomeningocele are not
at risk for microcephaly.
TEST-TAKING HINT: The test taker
should consider the diagnosis and choose
a response that best fits the current
diagnosis.
38. 1. Some children with myelomeningocele experience learning disabilities, but it is not
the most common complication.
2. Urinary tract infections are the most
common complication of myelomeningocele. Nearly all children with
myelomeningocele have a neurogenic
bladder that leads to incomplete emptying of the bladder and subsequent
urinary tract infections. Frequent
catheterization also increases
the risk of urinary tract infection.
3. Many children with myelomeningocele
experience hydrocephalus, but it is not the
most common complication.
4. Children with myelomeningocele are at
risk for skin breakdown and decubitus
ulcers, but they are not the most common
complications.
TEST-TAKING HINT: The test taker needs to
be familiar with the complications of
myelomeningocele. Neurogenic bladder is
the most common complication, so the
test taker should be led to select answer 2.
39. 1. Placing the child in the prone position is
correct. A dry dressing may adhere to the
defect, causing irritation.
2. A dry dressing may adhere to the defect,
causing irritation.
3. Oral gastric feedings are not usually
started unless there is going to be a delay
in surgery. The defect is usually corrected
within 24 hours to avoid infection.
4. The child is placed in the prone position to avoid any pressure on the
defect. A sterile moist dressing is
placed over the defect to keep it as
clean as possible. Intravenous fluids
are begun to prevent dehydration.
TEST-TAKING HINT: The test taker should
consider the location of the defect and
eliminate answer 1. Answer 2 should be
eliminated as a dry dressing could cause
irritation.
40. 1. The child with a neurogenic bladder will
never be able to spontaneously empty it
completely. Most children learn to
self-catheterize at a young age.
2. The child with a neurogenic bladder will
never be able to spontaneously empty it
completely.
3. Placing the child with a neurogenic
bladder on a bladder training program is
not helpful, as the child will never be able
to spontaneously empty it completely.
4. A vesicostomy is an example of an
option for children with myelomeningocele where alternatives to traditional
catheterizations are created.
TEST-TAKING HINT: The test taker should
recognize that the neurogenic bladder in
a child with myelomeningocele is irreversible, and answers 2 and 3 should be
eliminated.
41. 1. Children with myelomeningocele are
prone to latex allergies and therefore
should not eat bananas.
2. Children with myelomeningocele are
prone to latex allergies and therefore
should not be exposed to balloons.
3. Preventing skin breakdown is important
in the child with myelomeningocele, as
pressure points are not felt easily.
4. It is always important to provide education
on dietary needs, but it is not the priority
in the immediate post-operative period.
TEST-TAKING HINT: The test taker
should consider that children with
myelomeningocele are prone to latex
allergies and therefore should eliminate
answers 1 and 2.
42. 1. Although there is a cosmetic benefit, the
surgery is done to reconstruct the skull to
allow the brain to grow properly. There
are potential complications associated with
this surgery, such as increased ICP.
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2. The surgery is done to reconstruct
the skull to allow the brain to grow
properly. Because there are potential
complications associated with this surgery, such as increased ICP, the child is
usually closely observed in the PICU.
3. The surgery is not usually postponed but
done in early infancy..
4. The surgery is not usually postponed as it
will allow for brain growth.
TEST-TAKING HINT: The test taker should
consider the importance of allowing room
for brain growth. Answers 3 and 4 can
be eliminated because the surgery is
performed in early infancy.
43. 1. The infant needs to wear the helmet
23 hours daily. It is removed for bathing,
but not sleeping.
2. The helmet is most effective when the
child is younger, as the bones in the skull
are more malleable. The child is less likely
to need the helmet when upright and
mobile as there is less pressure in one area.
3. The helmet is worn 23 hours every day
and removed only for bathing.
4. Most children wear the helmet for 3 months.
TEST-TAKING HINT: The test taker
should recognize that the helmet is worn
23 hours daily and can eliminate answers
1, 2, and 4.
44. 1. The incidence of CP has increased
partly due to the increased survival
of extreme low-birth-weight and
premature infants.
2. The incidence of CP has increased since
the 1960s.
3. The incidence of CP has increased since
the 1960s.
4. There is no evidence to suggest that CP
has been diagnosed erroneously.
TEST-TAKING HINT: The test taker should
consider the causes of CP and be led to
answer 1 because technology has increased
the survival rate of low-birth-weight and
premature infants. The test taker should
resist the temptation to select answer 2
because it has not decreased like many
disorders.
45. 1. There is an increased incidence of CP
when the infant has an Apgar score of 3 or
less at 5 minutes.
2. Any infection of the central nervous
system increases the infant’s risk of CP.
3. A febrile seizure does not increase the
risk of CP.
4. Although head trauma can increase the risk
of CP, the school-age child is not likely to
develop CP from falling off a bike.
TEST-TAKING HINT: The test taker should
consider the risks for CP. Answers 3 and 4
should be eliminated because these symptoms are least likely to lead to CP.
46. 1. The startle reflex is expected in an infant
1 month old.
2. The clinical characteristic of hemiplegia can be manifested by the early
preference of one hand. This may be
an early sign of CP.
3. Although many children walk before the
age of 14 months, it is not considered a
motor delay not to have achieved this
milestone at this point.
4. Many 2-year-olds have not achieved
bladder control.
TEST-TAKING HINT: The test taker should
be familiar with normal developmental
milestones and eliminate answers 1, 3, and
4 because they are all developmentally
appropriate.
47. 1. CP is diagnosed based on clinical characteristics and developmental findings. It is
not diagnosed with any type of radiological
examination.
2. Although most cases of CP occur in the
neonatal period, some children can
develop CP at a later age.
3. The child will be given a chance to
recover and will be monitored closely
before a diagnosis is made.
4. Although many children develop CP
after having complications of meningitis,
many do not. Although the parents
should not be given false hope, they
should not be led to lose hope for a
complete recovery.
TEST-TAKING HINT: The test taker should
be led to answer 3 because it explains the
process and does not state that the child
definitely will or will not develop CP.
48. 1. The nurse cannot assume that the child
will have speech difficulties. Speech therapy does not guarantee vocalization at a
developmentally appropriate age.
2. Although speech therapy will assist with
babbling at a later age, its primary purpose
is to assist with feeding.
3. It is important to involve speech
therapy to strengthen tongue and jaw
movements to assist with feeding. The
infant who is at risk for CP may have
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weakened and uncoordinated tongue
and jaw movements.
4. Members of a multidisciplinary team
become involved in a child’s care based on
specific needs, not hospital routine.
TEST-TAKING HINT: The test taker should
immediately eliminate answer 4 because it
does not consider the child’s individual
needs.
49. 1. Baclofen is not given for post-operative
pain control.
2. Baclofen is not given for seizures.
3. Baclofen is given to help control the
spasms associated with CP.
4. Baclofen is not given for bladder control.
TEST-TAKING HINT: The test taker needs to
be familiar with the medication baclofen.
50. 1. CP is a nonprogressive disorder.
2. CP can manifest in different ways as the
child grows. It does not progress, but its
clinical manifestations may change.
3. Children with CP have different abilities
and needs. CP can result in mild to severe
motor deficits; therefore, one treatment
regimen cannot be used or recommended
for all children.
4. Although braces may assist some children
with ambulation, they will not be useful
in all cases.
TEST-TAKING HINT: The test taker can
eliminate answers 3 and 4 because generalizations cannot be made regarding CP.
Each child has different abilities and
disabilities.
51. 1. Sign language may help the child with
CP communicate and ultimately decrease frustration. Children with CP
may have difficulty verbalizing because
of weak tongue and jaw muscles. They
may be able to have sufficient motor
skills to communicate with their hands.
2. Sign language does not cause confusion
and may help reinforce vocabulary and
vocalization.
3. CP is manifested differently in all children; therefore, generalizations cannot
be made.
4. The earlier sign language is taught, the
more it will be beneficial.
TEST-TAKING HINT: The test taker can immediately eliminate answer 3 because it
makes a generalization. All forms of language are beneficial and well tolerated by
the children, especially young children.
52. 1. The food should be placed far back in
the mouth to avoid tongue thrust.
2. The child should be placed in an upright
position.
3. Soft and blended foods minimize the risk
of aspiration.
4. Allowing the child time to feed minimizes
the risk of aspiration.
TEST-TAKING HINT: The test taker should
consider which methods will decrease the
risk of aspiration. Answers 2, 3, and 4 all
decrease the risk of choking and should
be eliminated.
53. 1. Sharing information may not be helpful if
the family is not ready to listen.
2. Sharing information may not be helpful if
the family is not ready to listen.
3. The family may have other concerns that
would be communicated through an
open-ended question.
4. An open-ended question will encourage
family members to share what they know
and potentially clear any misconceptions.
TEST-TAKING HINT: The test taker should
consider the principles of therapeutic
communication. Answer 4 is an openended question that will not be perceived
as judgmental and should elicit the most
information.
54. 1. Neuroblastoma is not always cured and can
be fatal depending on the stage at diagnosis, site of origin, and the age of the child.
2. Infants younger than 1 year have the
best prognosis.
3. Infants younger than 1 year have the best
prognosis.
4. Although the prognosis varies with the site
of origin, infants have the most favorable
outcome.
TEST-TAKING HINT: The question
requires the test taker to be familiar
with the prognosis of neuroblastoma.
55. 1. Red blood cells will be needed to
increase the red blood cell count.
2. The child should not be around groups of
people due to the potential of exposure to
infection.
3. Blood thinners are not given to the child
with a decreased platelet count.
4. Fresh fruits and vegetables should be
avoided as they may contain microorganisms that can lead to infection in the child
with a low white blood cell count.
TEST-TAKING HINT: The test taker should
consider all components of pancytopenia
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and select the answer that will not harm
the child. Answers 3 and 4 should be
immediately eliminated because they
both increase the risk of infection.
56. 1. Although abdominal fullness is often seen,
difficulty urinating is not a common
symptom.
2. Bone manifestations are a sign of bone
metastasis, which is not seen in the early
stages of neuroblastoma.
3. The signs and symptoms vary depending on where the tumor is located, but
typical symptoms include weight loss,
abdominal distention, and fatigue.
4. The signs and symptoms vary according to
the location of the tumor. Generally,
hunger and weight gain are not seen.
TEST-TAKING HINT: The test taker should
eliminate answer 2 because bone metastases are a late sign, and the test taker is
looking for initial signs.
57. 1. In infants, signs and symptoms may
not be readily apparent as the open
fontanel allows for expansion.
2. Although brain tumors are not suspected
in infants, a delay in diagnosis is most
likely due to the open fontanel, allowing
some expansion to go unnoticed.
3. Signs and symptoms may be misinterpreted, but increased ICP will become
apparent.
4. Signs and symptoms may be denied, but
increased ICP will become apparent.
TEST-TAKING HINT: The test taker should
consider growth and development in
answering this question. The anterior
fontanel allows for brain expansion,
therefore delaying the discovery of
signs and symptoms of a brain tumor.
58. 1. The child is experiencing diabetes
insipidus, a common occurrence in children with midline brain tumors. Mannitol
is an osmotic diuretic that will not treat
diabetes insipidus.
2. The child is experiencing diabetes
insipidus, a common occurrence in
children with midline brain tumors.
Vasopressin is a hormone that is used
to help the body retain water.
3. The child is experiencing diabetes insipidus, a common occurrence in children
with midline brain tumors. Lasix is a diuretic that will not treat diabetes insipidus.
4. The child is experiencing diabetes insipidus,
a common occurrence in children with
midline brain tumors. Dopamine is a
beta-adrenergic agonist that is not used to
treat diabetes insipidus.
TEST-TAKING HINT: The test taker should
be familiar with diabetes insipidus. The
question describes its symptoms. Diabetes
insipidus commonly occurs in children
with midline brain tumors. The test taker
can eliminate answers 1 and 3 because
they increase diuresis, which needs to
be avoided.
59. 1. Not all children who receive radiation
experience learning disabilities.
2. Younger children tend to experience
more learning difficulties than do older
children.
3. Although variable, younger children
tend to experience more learning
difficulties than do older children.
4. Although variable, younger children tend
to experience more learning difficulties
than do older children.
TEST-TAKING HINT: The test taker should
be familiar with radiation therapy. The
test taker should be led to answers 3 and
4 because they both state that difficulties
are variable.
60. 1. The cervical collar should not be removed.
In addition to the methylprednisolone,
ranitidine should be administered to
prevent gastric ulcer formation.
2. All forms of spinal stabilization should
be continued while methylprednisolone
and ranitidine are administered.
3. The backboard and cervical collar should
not be removed until after the halo
traction has been applied.
4. The cervical collar should not be
removed.
TEST-TAKING HINT: The test taker should
be familiar with spinal cord injuries. The
test taker should eliminate any answer
stating the cervical collar be removed,
such as 1, 3, and 4.
61. 1, 2, 3, 4, 5.
1. Many metabolic disorders are associated
with hypoglycemia. The hypoglycemic
child experiences a decreased level of
consciousness as the brain does not
have stores of glucose.
2. Trauma can lead to generalized brain
swelling with resultant increased ICP.
3. Hypoxemia leads to a decreased level
of consciousness as the brain is
intolerant to the lack of oxygen.
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CHAPTER 5 NEUROLOGICAL DISORDERS
4. Dehydration can lead to inadequate
perfusion to the brain, which can result
in a decreased level of consciousness.
5. Endocrine disorders often result in a
decreased level of consciousness as
they can lead to hypoglycemia, which is
poorly tolerated by the brain.
TEST-TAKING HINT: Metabolic disorders,
trauma, hypoxic episodes, dehydration,
and endocrine disorders are examples of
disorders that can alter a child’s level of
consciousness by either increasing ICP or
decreasing the perfusion of blood to the
brain.
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Cardiovascular
Disorders
6
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Bacterial endocarditis
Cardiac demand
Defects with decreased pulmonary flow
Defects with increased pulmonary flow
Obstructive defects
ABBREVIATIONS
Angiotensin receptor blockers (ARB)
Aortic stenosis (AS)
Aspirin (ASA)
Atrial septal defect (ASD)
Atrioventricular canal (AVC)
Bacterial endocarditis (BE)
Blood pressure (BP)
Cardiac output (CO)
Cerebrovascular accident (CVA)
Coarctation of the aorta (COA)
Congenital heart defect (CHD)
Congestive heart failure (CHF)
Heart rate (HR)
Kawasaki disease (KD)
Left sternal border (LSB)
Patent ductus arteriosus (PDA)
Pulmonic stenosis (PS)
Rheumatic fever (RF)
Supraventricular tachycardia (SVT)
Systemic vascular resistance (SVR)
Tetralogy of Fallot (TOF)
Ventricular septal defect (VSD)
QUESTIONS
1. What can an electrocardiogram (ECG) detect? Select all that apply.
1. Ischemia.
2. Injury.
3. Cardiac output (CO).
4. Dysrhythmias.
5. Systemic vascular resistance (SVR).
6. Occlusion pressure.
7. Conduction delay.
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2. A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal
that the lumen of the duct between the aorta and pulmonary artery remains open.
This defect is known as _____________________.
3. Tetralogy of Fallot (TOF) involves which defects? Select all that apply.
1. Ventricular septal defect (VSD).
2. Right ventricular hypertrophy.
3. Left ventricular hypertrophy.
4. Pulmonic stenosis (PS).
5. Pulmonic atresia.
6. Overriding aorta.
7. Patent ductus arteriosus (PDA).
4. A 10-year-old child is recovering from a severe sore throat. The parent states that
the child complains of chest pain. The nurse observes that the child has swollen
joints, nodules on the fingers, and a rash on the chest. The likely cause is
_____________________.
5. What should the nurse assess prior to administering digoxin? Select all that apply.
1. Sclera.
2. Apical pulse rate.
3. Cough.
4. Liver function test.
6. Which statement by a parent of an infant with congestive heart failure (CHF) who is
being sent home on digoxin indicates the need for further education?
1. “I will give the medication at regular 12-hour intervals.”
2. “If he vomits, I will not give a make-up dose.”
3. “If I miss a dose, I will not give an extra dose”
4. “I will mix the digoxin in some formula to make it taste better.”
7. Which finding might delay a cardiac catheterization procedure on a 1-year-old?
1. 30th percentile for weight.
2. Severe diaper rash.
3. Allergy to soy.
4. Oxygen saturation of 91% on room air.
8. The nurse is caring for a child who has undergone a cardiac catheterization. During
recovery, the nurse notices the dressing is saturated with bright red blood. The
nurse’s first action is to:
1. Call the interventional cardiologist.
2. Notify the cardiac catheterization laboratory that the child will be returning.
3. Apply a bulky pressure dressing over the present dressing.
4. Apply direct pressure 1 inch above the puncture site.
9. Which interventions decrease cardiac demands in an infant with congestive heart
failure (CHF)? Select all that apply.
1. Allow parents to hold and rock their child.
2. Feed only when the infant is crying.
3. Keep the child uncovered to promote low body temperature.
4. Make frequent position changes.
5. Feed the child when sucking the fists.
6. Change bed linens only when necessary.
7. Organize nursing activities.
10. Indomethacin may be given to close which congenital heart defect (CHD) in
newborns? _____________________
11. For the child with hypoplastic left heart syndrome, which drug may be given to allow
the patent ductus arteriosus (PDA) to remain open until surgery?
_____________________
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CHAPTER 6 CARDIOVASCULAR DISORDERS
12. On examination, a nurse hears a murmur at the left sternal border (LSB) in a child
with diarrhea and fever. The parent asks why the pediatrician never said anything
about the murmur. The nurse explains:
1. “The pediatrician is not a cardiologist.”
2. “Murmurs are difficult to detect, especially in children.”
3. “The fever increased the intensity of the murmur.”
4. “We need to refer the child to an interventional cardiologist.”
13. While assessing a newborn with respiratory distress, the nurse auscultates a machine-like
heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased
PaCO2, and decreased PO2. The nurse suspects that the newborn has:
1. Pulmonary hypertension.
2. Patent ductus arteriosus (PDA).
3. Ventricular septal defect (VSD).
4. Bronchopulmonary dysplasia.
14. Which are the most serious complications for a child with Kawasaki disease (KD)?
Select all that apply.
1. Coronary thrombosis.
2. Coronary stenosis.
3. Coronary artery aneurysm.
4. Hypocoagulability.
5. Decreased sedimentation rate.
6. Hypoplastic left heart syndrome.
15. A child who has reddened eyes with no discharge; red, swollen, and peeling palms
and soles of the feet; dry, cracked lips; and a “strawberry tongue” most likely has
_____________________.
16. The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is
on the unit asks if there are medications to treat this disease. The nurse’s response to
the student nurse is:
1. Immunoglobulin G and aspirin.
2. Immunoglobulin G and ACE inhibitors.
3. Immunoglobulin E and heparin.
4. Immunoglobulin E and ibuprofen.
17. Congenital heart defects (CHDs) are classified by which of the following? Select all
that apply.
1. Cyanotic defect.
2. Acyanotic defect.
3. Defects with increased pulmonary blood flow.
4. Defects with decreased pulmonary blood flow.
5. Mixed defects.
6. Obstructive defects.
7. Pansystolic murmurs.
18. During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child
develops severe respiratory distress and becomes cyanotic. The nurse’s first action
should be to:
1. Lay the child flat to promote hemostasis.
2. Lay the child flat with legs elevated to increase blood flow to the heart.
3. Sit the child on the parent’s lap, with legs dangling, to promote venous pooling.
4. Hold the child in knee-chest position to decrease venous blood return.
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19. Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of
the following? Select all that apply.
1. Polycythemia.
2. Blood clots.
3. Cerebrovascular accident.
4. Developmental delays.
5. Viral pericarditis.
6. Brain damage.
7. Alkalosis.
20. A 6-month-old who has episodes of cyanosis after crying could have the congenital
heart defect (CHD) of decreased pulmonary blood flow called _____________________.
21. A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping
and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats
per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3
seconds. Which dysrhythmia does the nurse suspect in this child?
1. Rapid pulmonary flutter.
2. Sinus bradycardia.
3. Rapid atrial fibrillation.
4. Supraventricular tachycardia.
22. BP screenings to detect end-organ damage should be done routinely beginning at
what age?
1. Birth.
2. 3 years.
3. 8 years.
4. 13 years.
23. What associated manifestation might the nurse occasionally find in a child diagnosed
with Wilms tumor?
1. Atrial fibrillation.
2. Hypertension.
3. Endocarditis.
4. Hyperlipidemia.
24. Which drug should not be used to control secondary hypertension in a sexually
active adolescent female who uses intermittent birth control?
1. Beta blockers.
2. Calcium channel blockers.
3. ACE inhibitors.
4. Diuretics.
25. A 16-year-old being treated for hypertension has laboratory values of hemoglobin B
16 g/dL, hematocrit level 43%, sodium 139 mEq/L, potassium 4.4 mEq/L, and total
cholesterol of 220 mg/dL. Which drug does the nurse suspect the patient takes based
on the total cholesterol?
1. Beta blockers.
2. Calcium channel blockers.
3. ACE inhibitors.
4. Diuretics.
26. The _____________________ serves as the septal opening between the atria of the
fetal heart.
27. While looking through the chart of an infant with a congenital heart defect (CHD) of
decreased pulmonary blood flow, the nurse would expect which laboratory finding?
1. Decreased platelet count.
2. Polycythemia.
3. Decreased ferritin level.
4. Shift to the left.
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28. The nurse is caring for a 9-month-old who was born with a congenital heart defect
(CHD). Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral
crackles, and sweat on the scalp. These are signs of _____________________.
29. The following are examples of acquired heart disease. Select all that apply.
1. Infective endocarditis.
2. Hypoplastic left heart syndrome.
3. Rheumatic fever (RF).
4. Cardiomyopathy.
5. Kawasaki disease (KD).
6. Transposition of the great vessels.
30. A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses
of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights
in the room, and her HR is 70 beats per minute. The nurse expects which laboratory
finding?
1. Hypokalemia.
2. Hypomagnesemia.
3. Hypocalcemia.
4. Hypophosphatemia.
31. Which plan would be appropriate in helping to control congestive heart failure
(CHF) in an infant?
1. Promoting fluid restriction.
2. Feeding a low-salt formula.
3. Feeding in semi-Fowler position.
4. Encouraging breast milk.
32. In which congenital heart defect (CHD) would the nurse need to take upper and
lower extremity BPs?
1. Transposition of the great vessels.
2. Aortic stenosis (AS).
3. Coarctation of the aorta (COA).
4. Tetralogy of Fallot (TOF).
33. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure,
the nurse should first assess:
1. Pain.
2. Pulses.
3. Hemoglobin and hematocrit levels.
4. Catheterization report.
34. Which statement by the mother of a child with rheumatic fever (RF) shows she has
good understanding of the care of her child?
1. “I will apply heat to his swollen joints to promote circulation.”
2. “I will have him do gentle stretching exercises to prevent contractures.”
3. “I will give him the aspirin that is ordered for pain and inflammation.”
4. “I will apply cold packs to his swollen joints to reduce pain.”
35. A child has been diagnosed with valvular disease following rheumatic fever (RF).
During patient teaching, the nurse discusses the child’s long-term prophylactic
therapy with antibiotics for dental procedures, surgery, and childbirth. The parents
indicate they understand when they say:
1. “She will need to take the antibiotics until she is 18 years old.”
2. “She will need to take the antibiotics for 5 years after the last attack.”
3. “She will need to take the antibiotics for 10 years after the last attack.”
4. “She will need to take the antibiotics for the rest of her life.”
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36. A child born with Down syndrome should be evaluated for which associated cardiac
manifestation?
1. Congenital heart defect (CHD).
2. Systemic hypertension.
3. Hyperlipidemia.
4. Cardiomyopathy.
37. The Norwood procedure is used to correct:
1. Transposition of the great vessels.
2. Hypoplastic left heart syndrome.
3. Tetralogy of Fallot (TOF).
4. Patent ductus arteriosus (PDA).
38. A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular,
respiratory rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks
the caregiver about accidental ingestion of which drug?
1. Calcium channel blocker.
2. Beta blocker.
3. ACE inhibiter.
4. ARB.
39. Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)?
1. Chickenpox or influenza.
2. E. coli or staphylococcus.
3. Mumps or streptococcus A.
4. Streptococcus A or staphylococcus.
40. The nurse is caring for an 8-year-old girl whose parents indicate she has developed
spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur while
sleeping. The nurse questions the parents about which recent illness?
1. Kawasaki disease (KD).
2. Strep throat.
3. Malignant hypertension.
4. Atrial fibrillation.
41. The most common cardiac dysrhythmia in pediatrics is:
1. Ventricular tachycardia.
2. Sinus bradycardia.
3. Supraventricular tachycardia.
4. First-degree heart block.
42. A nursing action that promotes ideal nutrition in an infant with congestive heart
failure (CHF) is:
1. Feeding formula that is supplemented with additional calories.
2. Allowing the infant to nurse at each breast for 20 minutes.
3. Providing large feedings every 5 hours.
4. Using firm nipples with small openings to slow feedings.
43. An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization.
The mother expresses concern about the use of dye in the procedure. The child does
not have any allergies. In addition to the concern for an iodine allergy, what other
allergy should the nurse bring to the attention of the catheterization staff?
1. Soy.
2. Latex.
3. Penicillin.
4. Dairy.
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44. Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has
included digoxin and furosemide. The child no longer has retractions, lungs are clear ,
and HR is 96 beats per minute while the child sleeps. The nurse is confident that the
child has diuresed successfully and has good renal perfusion when the nurse notes the
child’s urine output is:
1. 0.5 cc/kg/hr.
2. 1 cc/kg/hr.
3. 30 cc/hr.
4. 1 oz/hr.
45. A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow
of blood through the heart is _____________________.
46. The parents of a 3-month-old ask why their baby will not have an operation to
correct a ventricular septal defect (VSD). The nurse’s best response is:
1. “It is always helpful to get a second opinion about any serious condition like this.”
2. “Your baby’s defect is small and will likely close on its own by 1 year of age.”
3. “It is common for physicians to wait until an infant develops respiratory distress
before they do the surgery.”
4. “With a small defect like this, they wait until the child is 10 years old to do the
surgery.”
47. The flow of blood through the heart with an atrial septal defect (ASD) is
_____________________.
48. Patent ductus arteriosus causes what type of shunt? _____________________
49. A child has been seen by the school nurse for dizziness since the start of the school
term. It happens when standing in line for recess and homeroom. The child now
reports that she would rather sit and watch her friends play hopscotch because she
cannot count out loud and jump at the same time. When the nurse asks her if her
chest ever hurts, she says yes. Based on this history, the nurse suspects that she has:
1. Ventricular septal defect (VSD).
2. Aortic stenosis (AS).
3. Mitral valve prolapse.
4. Tricuspid atresia.
50. The school nurse has been following a child who comes to the office frequently for
vague complaints of dizziness and headache. Today, she is brought in after fainting in
the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are
bounding. The nurse suspects she has:
1. Transposition of the great vessels.
2. Coarctation of the aorta (COA).
3. Aortic stenosis (AS).
4. Pulmonic stenosis (PS).
51. Which medication should the nurse give to a child diagnosed with transposition of
the great vessels?
1. Ibuprofen.
2. Betamethasone.
3. Prostaglandin E.
4. Indocin.
52. Which statement by the mother of a child with rheumatic fever (RF) shows she has
an understanding of prevention for her other children?
1. “Whenever one of them gets a sore throat, I will give that child an antibiotic.”
2. “There is no treatment. It must run its course.”
3. “If their culture is positive for group A streptococcus, I will give them their
antibiotic.”
4. “If their culture is positive for staphylococcus A, I will give them their antibiotic.”
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53. Which patient could require feeding by gavage?
1. Infant with congestive heart failure (CHF).
2. Toddler with repair of transposition of the great vessels.
3. Toddler with Kawasaki disease (KD) in the acute phase.
4. School-age child with rheumatic fever (RF) and chorea.
54. Which physiological changes occur as a result of hypoxemia in congestive heart
failure (CHF)?
1. Polycythemia and clubbing.
2. Anemia and barrel chest.
3. Increased white blood cells and low platelets.
4. Elevated erythrocyte sedimentation rate and peripheral edema.
55. Aspirin has been ordered for the child with rheumatic fever (RF) in order to:
1. Keep the patent ductus arteriosus (PDA) open.
2. Reduce joint inflammation.
3. Decrease swelling of strawberry tongue.
4. Treat ventricular hypertrophy of endocarditis.
56. Which vaccines must be delayed for 11 months after the administration of gamma
globulin? Select all that apply.
1. Diphtheria, tetanus, and pertussis.
2. Hepatitis B.
3. Inactivated polio virus.
4. Measles, mumps, and rubella.
5. Varicella.
57. The mother of a toddler reports that the child’s father has just had a myocardial
infarction (MI). Because of this information, the nurse recommends the child have a(n):
1. Electrocardiogram.
2. Lipid profile.
3. Echocardiogram.
4. Cardiac catheterization.
58. During play, a toddler with a history of tetralogy of Fallot (TOF) might assume
which position?
1. Sitting.
2. Supine.
3. Squatting.
4. Standing.
59. A heart transplant may be indicated for a child with severe heart failure and:
1. Patent ductus arteriosus (PDA).
2. Ventricular septal defect (VSD).
3. Hypoplastic left heart syndrome.
4. Pulmonic stenosis (PS).
60. Family discharge teaching has been effective when the parent of a toddler diagnosed
with Kawasaki disease (KD) states:
1. “The arthritis in her knees is permanent. She will need knee replacements.”
2. “I will give her diphenhydramine (Benadryl) for her peeling palms and soles
of her feet.”
3. “I know she will be irritable for 2 months after her symptoms started.”
4. “I will continue with high doses of Tylenol for her inflammation.”
61. Which assessment indicates that the parent of a 7-year-old is following the
prescribed treatment for congestive heart failure (CHF)?
1. HR of 56 beats per minute.
2. Elevated red blood cell count.
3. 50th percentile height and weight for age.
4. Urine output of 0.5 cc/kg/hr.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1, 2, 4, 7.
1. An electrocardiogram can indicate
ischemia of the heart muscle.
2. An electrocardiogram can indicate
injury to the heart muscle.
3. An electrocardiogram does not
indicate CO.
4. An electrocardiogram can show
dysrhythmias.
5. An electrocardiogram does not show SVR.
6. An electrocardiogram does not show
occlusion pressures.
7. An electrocardiogram does show
conduction delays.
TEST-TAKING HINT: The electrocardiogram
checks the electrical system of the heart, not
the mechanical system. CO is mechanical;
occlusion pressure does not have to do with
the electrocardiogram; and SVR measures
pressures in the peripheral system.
2. Patent ductus arteriosus or PDA.
TEST-TAKING HINT: This is a defect with
increased pulmonary flow. It should close
in the first few weeks of life.
3. 1, 2, 4, 6.
1. TOF is a congenital defect with a ventricular septal defect, right ventricular
hypertrophy, pulmonary valve stenosis,
and overriding aorta.
2. TOF is a congenital defect with ventricular septal defect, right ventricular
hypertrophy, pulmonary valve stenosis,
and overriding aorta.
3. TOF is a congenital defect with ventricular
septal defect, right ventricular hypertrophy,
pulmonary valve stenosis, and overriding
aorta.
4. TOF is a congenital defect with ventricular septal defect, right ventricular
hypertrophy, pulmonary valve stenosis,
and overriding aorta.
5. TOF is a congenital defect with ventricular
septal defect, right ventricular hypertrophy,
pulmonary valve stenosis, and overriding
aorta.
6. TOF is a congenital defect with ventricular septal defect, right ventricular
hypertrophy, pulmonary valve stenosis,
and overriding aorta.
7. PDA is not one of the defects in tetralogy
of Fallot.
TEST-TAKING HINT: Tetralogy of Fallot has
four defects. Pulmonary stenosis causes
decreased pulmonary flow.
4. Rheumatic fever or RF.
To make the diagnosis of RF, major and minor
criteria are used. Major criteria include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria
include fever and previous history of RF.
TEST-TAKING HINT: It is an inflammatory
disease caused by group A beta-hemolytic
streptococcus.
5. 1. The sclera has nothing to do with CHF.
2. The apical pulse rate is assessed because
digoxin decreases the HR, and if the
HR is <60, digoxin should not be
administered.
3. Cough would not be assessed before administration. It is more commonly seen in patients
who have been prescribed ACE inhibitors.
4. Liver function tests are not assessed before
digoxin is administered. Digoxin can lower
HR and cause dysrhythmias.
TEST-TAKING HINT: The test taker should
know that the sclera and liver function tests
have nothing to do with digoxin. Cough
could be associated with ACE inhibitors.
6. 1.
2.
3.
4.
This is appropriate for digoxin administration.
This is appropriate for digoxin administration.
This is appropriate for digoxin administration.
If the medication is mixed in his formula,
and he refuses to drink the entire amount,
the digoxin dose will be inadequate.
TEST-TAKING HINT: What if the child does
not drink all the formula?
7. 1. This may be a reason the child needs the
catheterization.
2. A child with severe diaper rash has
potential for infection if the interventionist makes the standard groin
approach.
3. Shellfish, not soy, is an allergy concern.
4. This may be a reason the child needs the
catheterization.
TEST-TAKING HINT: Consider the risk for
infection as a delaying factor.
8. 1. This is not an appropriate action.
2. This is not an appropriate action.
3. This can be done after applying direct
pressure 1 inch above the puncture site.
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4. Applying direct pressure 1 inch above
the puncture site will localize pressure
over the vessel site.
TEST-TAKING HINT: Consider the risk for
volume depletion.
9. 1, 4, 5, 6, 7.
1. Rocking by the parents will comfort
the infant and decrease demands.
2. The infant would not be fed when crying
because crying increases cardiac demands.
The infant might choke if the nipple is
placed in the mouth and the child inhales
when trying to swallow.
3. Keep the child normothermic to reduce
metabolic demands.
4. Frequent position changes will decrease the risk for infection by avoiding immobility with its potential for
skin breakdown.
5. An infant sucking the fists could
indicate hunger.
6. Change bed linens only when necessary to avoid disturbing the child.
7. Organize nursing activities to avoid
disturbing the child.
TEST-TAKING HINT: Do all that can be done
to decrease demands on the child.
10. Patent ductus arteriosus or PDA.
TEST-TAKING HINT: Prostaglandins allow
the duct to remain open; thus, a
prostaglandin inhibitor, such as Indocin or
ibuprofen, can help close the duct.
11. Prostaglandin E.
TEST-TAKING HINT: Prostaglandin E main-
tains ductal patency to promote blood flow
until the Norwood procedure is begun.
Consider the opposite of wanting to close
the PDA.
12. 1. This is not a collegial response.
2. The increased CO of the fever increases
the intensity of the murmur, making it
easier to hear.
3. The increased CO of the fever
increases the intensity of the murmur,
making it easier to hear.
4. This child does not need to see an
interventional cardiologist. The murmur
needs to be diagnosed first, and then a
treatment plan would be developed.
TEST-TAKING HINT: Consider the pathophysiology of fever.
13. 1. Pulmonary hypertension is a pulmonary
condition, which does not create a heart
murmur.
2. The main identifier in the stem is the
machine-like murmur, which is the
hallmark of a PDA.
3. A VSD does not produce a machine-like
murmur.
4. Bronchopulmonary dysplasia is a pulmonary condition, which does not create
a heart murmur.
TEST-TAKING HINT: The test taker need to
know common murmur sounds.
14. 1, 2, 3.
1. Thrombosis, stenosis, and aneurysm
affect blood vessels. The child with
KD has hypercoagulability and an
increased sedimentation rate due to
inflammation.
2. Thrombosis, stenosis, and aneurysm
affect blood vessels. The child with
KD has hypercoagulability and an
increased sedimentation rate due to
inflammation.
3. Thrombosis, stenosis, and aneurysm
affect blood vessels. The child with
KD has hypercoagulability and an
increased sedimentation rate due to
inflammation.
4. The child with KD has hypercoagulability
and an increased sedimentation rate due
to inflammation.
5. The child with KD has hypercoagulability
and an increased sedimentation rate due
to inflammation.
6. Hypoplastic left heart syndrome is a
CHD and has no relation to KD.
TEST-TAKING HINT: KD is an inflammation
of small- and medium-sized blood vessels.
15. Kawasaki disease or KD.
TEST-TAKING HINT: Classic signs of KD
include red eyes with no discharge; dry,
cracked lips; strawberry tongue; and red,
swollen, and peeling palms and soles of
the feet. Incidence of KD is higher in
males. The strongest indicator for this
disease is the hallmark strawberry
tongue.
16. 1. High-dose immunoglobulin G and
salicylate therapy for inflammation
are the current treatment for KD.
2. Immunoglobulin G is correct, but ACE
inhibitors are incorrect for treatment.
3. Heparin may be used for the child
with an aneurysm, but not immunoglobulin E.
4. Immunoglobulin E and ibuprofen are not
correct.
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TEST-TAKING HINT: Consider antiinflammatory medications for treatment
of KD.
17. 3, 4, 5, 6.
1. Heart defects are no longer classified as
cyanotic or acyanotic.
2. Heart defects are no longer classified as
cyanotic or acyanotic.
3. Heart defects are now classified as
defects with increased or decreased
pulmonary blood flow.
4. Heart defects are now classified as
defects with increased or decreased
pulmonary blood flow.
5. Heart defects are now classified as
defects with increased or decreased
pulmonary blood flow.
6. Heart defects are now classified as
defects with increased or decreased
pulmonary blood flow.
7. A murmur may be heard with a CHD,
but a murmur does not classify the defect.
TEST-TAKING HINT: Know the new
classifications, not the older ones.
18. 1. Laying the child flat would increase preload, increasing blood to the heart, therefore making respiratory distress worse.
2. Laying the child flat with legs elevated
would increase preload, increasing blood
to the heart, therefore making respiratory
distress worse.
3. Sitting the child on the parent’s lap with
legs dangling might possibly help, but
it would not be as effective as the kneechest position in occluding the venous
return.
4. The increase in the SVR would increase
afterload and increase blood return to
the pulmonary artery.
TEST-TAKING HINT: The test taker should
choose the response that decreases the
preload in this patient.
19. 1, 2, 3, 4, 6.
1. Hypoxia causes polycythemia, which can
lead to increased blood viscosity, which
can lead to blood clots and a stroke.
2. Hypoxia causes polycythemia, which can
lead to increased blood viscosity, which
can lead to blood clots and a stroke.
3. Hypoxia causes polycythemia, which
can lead to increased blood viscosity,
which can lead to blood clots and a
stroke.
4. Developmental delays can be caused
by multiple hospitalizations and
surgeries. The child usually catches up
to the appropriate level.
5. Hypoxia can increase the risk for bacterial
endocarditis, not viral pericarditis.
6. Brain damage can be caused by
hypoxia, blood clots, and stroke.
7. Hypoxic episodes cause acidosis, not
alkalosis.
TEST-TAKING HINT: Hypoxic episodes in a
child with CHD (“tet spells”) can cause
polycythemia and strokes.
20. Tetralogy of Fallot or TOF.
“Tet” spells are characteristic of TOF.
TEST-TAKING HINT: Know the congenital
heart defect classifications.
21. 1. This is not a real dysrhythmia.
2. Sinus bradycardia is a slow rate for the
child’s age.
3. Rapid atrial fibrillation is an irregular
rhythm.
4. SVT is often above 200 and a result
of dehydration, which a vomiting child
could have. The rapid rate causes a
low CO, resulting in low BP and
prolonged capillary refill.
TEST-TAKING HINT: The HR is regular and
very rapid for a child of any age. The
child has been vomiting, which can result
in dehydration.
22. 1. Birth is too early, and readings are often
not reliable due to patient movement.
2. Age 3 years is the recommended age
to establish a baseline BP in a normal
healthy child.
3. Age 8 years is too late to detect early
damage.
4. Age 13 years is too late to detect early
damage.
TEST-TAKING HINT: The test taker needs
to know that 3 years of age is the recommended age to begin BP measurements
in healthy children.
23. 1. Wilms tumor does not affect or cause this
condition.
2. Because Wilms tumor sits on the kidney, it can be associated with secondary
hypertension. It does not affect or
cause the other conditions.
3. Wilms tumor does not affect or cause this
condition.
4. Wilms tumor does not affect or cause this
condition.
TEST-TAKING HINT: Where is the Wilms
tumor located?
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24. 1. ACE inhibitors and angiotensin II receptor
blockers can cause birth defects. The
others are not teratogenic.
2. ACE inhibitors and angiotensin II receptor
blockers can cause birth defects. The
others are not teratogenic.
3. ACE inhibitors and angiotensin II
receptor blockers can cause birth defects. The others are not teratogenic.
4. ACE inhibitors and angiotensin II receptors can cause birth defects. The others
are not teratogenic.
TEST-TAKING HINT: The test taker needs to
know which of these drugs are teratogenic.
25. 1. Beta blockers are used with caution in
patients with hyperlipidemia, hyperglycemia, and impotence.
2. Calcium channel blockers do not affect
these blood levels.
3. ACE inhibitors do not affect these blood
levels.
4. Diuretics do not affect these blood levels.
TEST-TAKING HINT: The test taker needs to
know side effects of drugs.
26. Foramen ovale.
TEST-TAKING HINT: The foramen ovale is
the septal opening between the atria of
the fetal heart. The test taker needs to
know basic fetal circulation.
27. 1. The nurse should expect a normal platelet
count in an infant with a CHD of
decreased pulmonary blood flow.
2. Polycythemia is the result of the body
attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood
cells to carry the oxygen.
3. Ferritin measures the amount of iron
stored in the body and not affected by
decreased pulmonary blood flow.
4. “Shift to the left” refers to an increase in
the number of immature white blood cells.
TEST-TAKING HINT: The test taker needs to
know what laboratory values hypoxia can
affect.
28. Congestive heart failure or CHF.
TEST-TAKING HINT: All of these are signs of
pump failure. The infant is likely to have
diaphoresis only on the scalp. The signs
are not unlike those of an adult with this
condition.
29. 1, 3, 4, 5.
1. Infective endocarditis is an example of
an acquired heart problem.
2. Hypoplastic left heart syndrome is a CHD.
3. RF is an acquired heart problem.
4. Cardiomyopathy is an acquired heart
problem.
5. KD is an acquired heart problem.
6. Transposition of the great vessels is a CHD.
TEST-TAKING HINT: “Acquired” means
occurring after birth and seen in an
otherwise normal and healthy heart.
30. 1. The rubbing of the child’s eyes may
mean that she is seeing halos around
the lights, indicating digoxin toxicity.
The HR is slow for her age and also
indicates digoxin toxicity. A decrease
in serum potassium because of the
furosemide can increase the risk for
digoxin toxicity.
2. Hypomagnesemia does not affect digoxin
and is not related to the child rubbing her
eyes.
3. Hypocalcemia does not affect digoxin and
is not related to the child rubbing her
eyes.
4. Hypophosphatemia does not affect
digoxin and is not related to the child
rubbing her eyes.
TEST-TAKING HINT: The test taker knows
that furosemide causes the loss of potassium and can cause digoxin toxicity.
31. 1. The nurse would not need to restrict
fluids, as the child likely would not be
getting overloaded with oral fluids.
2. The infant likely will have sodium
depletion because of the chronic diuretic
use; the infant needs a normal source of
sodium, so low-sodium formula would
not be used.
3. The infant has a great deal of difficulty
feeding with CHF, so even getting the
maintenance fluids is a challenge. The
infant is fed in the more upright position so fluid in the lungs can go to the
base of the lungs, allowing better
expansion.
4. Breast milk has slightly less sodium than
formula, and the child needs a normal
source of sodium because of the diuretic.
TEST-TAKING HINT: Infants are not able to
concentrate urine well and may have
sodium depletion, so they need a normal
source of sodium.
32. 1. BPs would not need to be taken in both
the upper and lower extremities in transposition of the great vessels. The aorta
and pulmonary arteries are in opposite
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positions, which does not change the BP
readings.
2. AS is a narrowing of the aortic valve,
which does not affect the BP in the
extremities.
3. With COA there is narrowing of the
aorta, which increases pressure proximal to the defect (upper extremities)
and decreases pressure distal to the
defect (lower extremities). There
will be high BP and strong pulses
in the upper extremities and lowerthan-expected BP and weak pulses
in the lower extremities.
4. TOF is a congenital cardiac problem with
four defects that do not affect the BP in
the extremities.
TEST-TAKING HINT: The test taker must
know the anatomy of the defects and what
assessments are to be made in each one.
33. 1. Pain needs to be assessed post procedure
but is not the priority.
2. Checking for pulses, especially in the
canulated extremity, would assure
perfusion to that extremity and is the
priority post procedure.
3. Hemoglobin and hematocrit levels would
be checked post procedure if the child
had bled very much during or after the
procedure.
4. The catheterization report would be of
interest to know what was determined from
the procedure. This would also be good to
check on the patient post procedure.
TEST-TAKING HINT: The test taker would
know that the priority is assessing the
cannulated extremity, checking for
adequate perfusion.
34. 1. During the acute phase, limit any manipulation of the joint, and avoid heat or cold.
2. During the acute phase, limit any manipulation of the joint, and avoid heat or cold.
3. Aspirin is the drug of choice for
treatment of RF.
4. During the acute phase, limit any
manipulation of the joint, and avoid
heat or cold.
TEST-TAKING HINT: The test taker should
know that aspirin is the drug of choice
and that manipulation of the joint should
be limited during the acute phase.
35. 1. This could be true for a patient with a
less severe form of RF.
2. This could be true for a patient with a
less severe form of RF.
3. This could be true for a patient with a
less severe form of RF.
4. Valvular involvement indicates significant damage, so antibiotics would be
taken for the rest of her life.
TEST-TAKING HINT: The test taker would
know that the severity of the damage to
the heart valves determines how long prophylaxic antibiotics will be administered.
36. 1. CHD is found often in children with
Down syndrome.
2. This is not associated with Down
syndrome.
3. This is not associated with Down
syndrome.
4. This is not associated with Down
syndrome.
TEST-TAKING HINT: A child with a
syndrome, such as Down, is likely to
have other abnormalities.
37. 1. Transposition of the great vessels requires
different surgical procedures.
2. The Norwood procedure is specific to
hypoplastic left heart syndrome.
3. TOF requires different surgical procedures.
4. PDA requires different surgical procedures.
TEST-TAKING HINT: Review surgical
treatment of CHD.
38. 1. Calcium channel blockers decrease the
force of cardiac contraction and slow the
electrical conduction of the heart, resulting in slowing of the HR. The HR is
normal in this child.
2. The beta blocker not only affects the
heart and lungs but also blocks the beta
sites in the liver, reducing the amount
of glycogen available for use, causing
hypoglycemia. The lower HR and BP
also suggest ingestion of a cardiac
medication.
3. ACE inhibiters block the conversion of a
protein from its inactive to its active
form. The protein causes constriction of
small blood vessels, which raises BP. By
blocking this protein, BP is lowered.
4. Angiotensin receptor blockers relax blood
vessels, which lowers BP and makes it
easier for the heart to pump blood.
TEST-TAKING HINT: Know the drug’s side
effects. In this case, the glucose is blocked.
39. 1. Both chickenpox and influenza are
viral in nature, so consider stopping
the aspirin because of the danger of
Reye syndrome.
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2. E. coli and staphylococcus are not viral, so
Reye syndrome is not a factor.
3. Mumps is caused by a virus, so aspirin
should not be used to treat fever. Streptococcus A is a bacterium; Reye syndrome is
not a factor.
4. Streptococcus A and staphylococcus are
not viral, so Reye syndrome is not a factor.
TEST-TAKING HINT: Consider Reye syndrome when the patient is taking aspirin
and has a viral infection.
40. 1. KD does not result in this condition,
called chorea or St. Vitus’ dance.
2. Chorea can be a manifestation of RF,
with a higher incidence in females.
3. Malignant hypertension does not result in
this condition, called chorea or St. Vitus’
dance.
4. Atrial fibrillation is not an illness.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because KD can cause
damage to coronary arteries.
41. 1. Ventricular tachycardia is uncommon in
children.
2. Sinus bradycardia is uncommon in
children.
3. Supraventricular tachycardia is most
common in children.
4. First-degree heart block is uncommon in
children.
TEST-TAKING HINT: Consider a tachycardiac
rhythm in a pediatric patient.
42. 1. Formula can be supplemented with
extra calories, either from a commercial supplement, such as Polycose, or
from corn syrup. Calories in formula
could increase from 20 kcal/oz to
30 kcal/oz or more.
2. The infant would get too tired while
feeding, which increases cardiac demand.
Limit breastfeeding to a half hour, or
15 minutes per side.
3. Smaller feedings more often, such as
every 2 to 3 hours, would decrease cardiac
demand.
4. Soft nipples that are easy for the infant
to suck would make for less work getting
nutrition.
TEST-TAKING HINT: Allow the child to get
the most nutrition most effectively.
43. 1. Children with spina bifida (myelomeningocele) often have a latex allergy.
The catheter balloon is often made of
latex, and all personnel caring for the
patient should be made aware of the
allergy.
2. Children with spina bifida (myelomeningocele) often have a latex allergy.
The catheter balloon is often made of
latex, and all personnel caring for the
patient should be made aware of the
allergy.
3. Children with spina bifida (myelomeningocele) often have a latex allergy.
The catheter balloon is often made of
latex, and all personnel caring for the
patient should be made aware of the
allergy.
4. Children with spina bifida (myelomeningocele) often have a latex allergy.
The catheter balloon is often made of
latex, and all personnel caring for the
patient should be made aware of the
allergy.
TEST-TAKING HINT: Material that composes
the balloon catheter is made of latex,
which is a common allergy in a child with
a myelomeningocele.
44. 1. This is incorrect because 0.5 cc/kg/hr is
below the normal pediatric urine output.
2. Normal pediatric urine output is
1 cc/kg/hr.
3. This is incorrect because 30 cc/hr is
above the normal pediatric urine output.
4. This is incorrect because 1 oz/hr is above
the normal pediatric urine output.
TEST-TAKING HINT: The test taker needs to
know that normal urine output for a child
is 1 cc/kg/hr.
45. Left to right. The pressures in the left
side of the heart are greater, causing the
flow of blood to be from an area of higher
pressure to lower pressure, or left to
right, increasing the pulmonary blood
flow with the extra blood.
TEST-TAKING HINT: The test taker should
know that the classification for this defect
is left to right.
46. 1. This is not a collegial response, and the
nurse should explain to the parents why
an operation is not necessary now.
2. Usually a VSD will close on its own
within the first year of life.
3. It is not common for physicians to wait
until respiratory distress develops because
that puts the infant at greater risk for
complications. The defect is small and
will likely close on its own.
4. Small defects usually close on their own
within the first year.
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TEST-TAKING HINT: Know the various
treatments depending on size of the
defect. VSD is the most common CHD.
47. Left to right. The pressures in the left
side of the heart are greater, causing the
flow of blood to be from an area of higher
pressure to lower pressure, or left to
right, increasing the pulmonary blood
flow with the extra blood.
TEST-TAKING HINT: What is the CHD
classification of ASD?
48. Left to right. Blood flows from the higher
pressure aorta to the lower pressure
pulmonary artery, resulting in a left to
right shunt.
TEST-TAKING HINT: What is the CHD
classification of PDA?
49. 1. Murmur and CHF are often found in
infancy.
2. AS can progress, and the child can
develop exercise intolerance that can
be better when resting.
3. Mitral valve prolapse causes a murmur
and palpitations, usually in adulthood.
4. Tricuspid atresia causes hypoxemia in
infancy.
TEST-TAKING HINT: What does each of the
last words of the defects mean, and what
do those cause?
50. 1. Transposition of the great vessels does not
cause these symptoms.
2. In the older child, COA causes dizziness, headache, fainting, elevated blood
pressure, and bounding radial pulses.
3. AS does not cause these symptoms.
4. PS does not cause these symptoms.
TEST-TAKING HINT: The test taker should
recognize that the child’s BP is elevated
and her pulses are bounding, which are
symptoms of COA.
51. 1. Ibuprofen blocks prostaglandins, which
would speed up the closing of the PDA.
2. Betamethasone blocks prostaglandins,
which would speed up the closing of the
PDA.
3. Prostaglandin E inhibits closing of the
PDA, which connects the aorta and
pulmonary artery.
4. Indocin is used to treat osteoarthritis and
gout.
TEST-TAKING HINT: The test taker would
know that children who have transposition
of the great vessels also have another cardiac defect, and the common one is PDA.
52. 1, 3.
1. Do not use an antibiotic if the disease
is not bacterial in origin. Most sore
throats are viral.
2. RF is a bacterial infection caused by
group A beta-hemolytic streptococcus,
and the drug of choice is penicillin.
3. RF is caused by a streptococcus
infection, not by staphylococcus.
4. RF is cause by a streptococcus infection,
not by staphylococcus.
TEST-TAKING HINT: The test taker needs to
know the cause of RF and how it is
treated.
53. 1. The child may experience increased
cardiac demand while feeding. Feedings by gavage eliminate that work
and still provide high-calorie intake for
growth.
2. Transposition of the great vessels should
be repaired before the toddler years,
so that child would not need to be
gavage-fed.
3. A toddler with KD in the acute phase
does not need to be gavage-fed.
4. An RF patient with St. Vitus’ dance
(chorea) does not need to be gavage-fed.
Most of these children do not have CHF.
TEST-TAKING HINT: The test taker should
consider how gavage feedings would
affect the work of the heart.
54. 1. The hypoxemia stimulates erythropoiesis, which causes polycythemia,
in an attempt to increase oxygen by
having more red blood cells carry
oxygen. Clubbing of the fingers is
a result of the polycythemia and
hypoxemia.
2. Anemia and barrel chest do not occur as a
result of hypoxemia. Hypoxemia stimulates the production of erythropoietin to
increase the number of red blood cells to
carry more oxygen. The barrel chest is
the result of air trapping.
3. Increased white blood cells occur as the
result of an infection, not hypoxemia.
Hypoxemia does not cause a decreased
number of platelets.
4. An elevated erythrocyte sedimentation
rate is the result of inflammation in the
body. Peripheral edema can be caused
by CHF.
TEST-TAKING HINT: The test taker could
eliminate answers 2, 3, and 4 by knowing
that they do not cause hypoxemia in CHF.
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55. 1. Aspirin is not used to treat this condition.
A PDA does not occur with RF.
2. Joint inflammation is experienced in
RF; aspirin therapy helps with
inflammation and pain.
3. Strawberry tongue is manifested in KD;
aspirin is not used to treat this disease.
4. Aspirin is not used to treat this condition.
TEST-TAKING HINT: Know the manifestations of RF.
56. 4, 5.
1. Diphtheria, tetanus, and pertussis can be
given following administration of gamma
globulin. These are killed vaccines, and
the only vaccines not administered would
be live vaccines such as measles, mumps,
rubella.
2. Hepatitis B can be administered following
gamma globulin. Live vaccines are held
for at least 11 months.
3. Inactivated polio virus can be given
following gamma globulin administration.
Live vaccines are held for 11 months.
4. The body might not produce the
appropriate number of antibodies
following gamma globulin infusion,
so live virus vaccines should be
delayed for 11 months.
5. The body might not produce the
appropriate number of antibodies
following gamma globulin infusion, so
live virus vaccines should be delayed
for 11 months.
TEST-TAKING HINT: The test taker needs to
know which vaccines are killed and which
are live.
57. 1. Current recommendations are for a lipid
profile in children over 2 years with a
first- or second-degree relative with
stroke, myocardial infarction, angina, or
sudden cardiac death. Also screen if
parent, sibling, or grandparent has
cholesterol of 240 mg/dL or greater.
2. Current recommendations are for a
lipid profile in children over 2 years
with a first- or second-degree relative
with stroke, myocardial infarction,
angina, or sudden cardiac death. Also
screen if parent, sibling, or grandparent has cholesterol of 240 mg/dL or
greater.
3. Current recommendations are for a lipid
profile in children over 2 years with a
first- or second-degree relative with
stroke, myocardial infarction, angina, or
sudden cardiac death. Also screen if
parent, sibling, or grandparent has
cholesterol of 240 mg/dL or greater.
4. Current recommendations are for a lipid
profile in children over 2 years with a
first- or second-degree relative with
stroke, myocardial infarction, angina, or
sudden cardiac death. Also screen if
parent, sibling, or grandparent has
cholesterol of 240 mg/dL or greater.
TEST-TAKING HINT: Think about the cause
of the father’s MI.
58. 1. The toddler will naturally assume this
position to decrease preload by occluding
venous flow from the lower extremities
and increasing afterload. Increasing SVR
in this position increases pulmonary
blood flow. This occurs with squatting.
2. The toddler will naturally assume this
position to decrease preload by occluding
venous flow from the lower extremities
and increasing afterload. Increasing SVR
in this position increases pulmonary
blood flow. This occurs with squatting.
3. The toddler will naturally assume this
position to decrease preload by
occluding venous flow from the lower
extremities and increasing afterload.
Increasing SVR in this position
increases pulmonary blood flow.
4. The toddler will naturally assume this
position to decrease preload by occluding
venous flow from the lower extremities
and increasing afterload. Increasing SVR
in this position increases pulmonary
blood flow.
TEST-TAKING HINT: The child self-assumes
this position during the spell.
59. 1. Severe heart failure can be an indication
for heart transplant if quality of life is
decreased.
2. Severe heart failure can be an indication
for heart transplant if quality of life is
decreased.
3. Hypoplastic left heart syndrome is
treated by the Norwood procedure,
or heart transplant.
4. Severe heart failure can be an indication
for heart transplant if quality of life is
decreased.
TEST-TAKING HINT: Consider severe heart
failure and which complex of CHD.
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60. 1. Arthritis in KD is always temporary.
2. Peeling palms and feet are painless.
3. Children can be irritable for 2 months
after the symptoms of the disease
start.
4. Tylenol is never given in high doses due
to liver failure, and it is not an antiinflammatory. Aspirin is given in high
doses for KD.
TEST-TAKING HINT: The test taker must
know about KD to choose the best
response.
61. 1. HR of 56 beats per minute is likely due to
digoxin toxicity.
2. Elevated count of red blood cells indicates
polycythemia secondary to hypoxemia.
3. The 50th percentile height and weight
for age shows good growth and development, indicating good nutrition and
perfusion.
4. Urine output of 0.5 cc/kg/hr indicates
that furosemide is not being given as
ordered; the output is too low.
TEST-TAKING HINT: The test taker
should know the expected responses of
medications used to treat CHF.
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Hematological
or Immunological
Disorders
7
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Aplastic anemia
Beta-thalassemia (Cooley anemia or
thalassemia major)
Central nervous system prophylaxis
Chelation therapy
Factor VIII deficiency
Hemarthrosis
Hemophilia A
Hodgkin disease
Immunosuppressive
Intrathecal chemotherapy
Leukemia
Mucositis
Neuroblastoma
Neutropenia
Non-Hodgkin lymphoma
Osteosarcoma
Pancytopenia
Polycythemia
Polycythemia vera
Purpura
Reed-Sternberg cells
Sickle cell disease (sickle cell anemia)
Splenic sequestration
Thrombocytopenia
Vaso-occlusive crises
Von Willebrand disease
Wilms tumor
ABBREVIATIONS
Acute lymphoblastic leukemia (ALL)
Cytomegalovirus (CMV)
Idiopathic thrombocytopenia purpura (ITP)
Pneumocystis carinii pneumonia or
pneumocystic pneumonia (PCP)
Severe combined immunodeficiency
disease (SCID)
Vanillylmandelic acid (VMA)
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QUESTIONS
1. The nurse is taking care of a child with sickle cell disease. The nurse is aware that
which of the following problems is (are) associated with sickle cell disease? Select all
that apply.
1. Polycythemia.
2. Hemarthrosis.
3. Aplastic crisis.
4. Thrombocytopenia.
5. Splenic sequestration.
6. Vaso-occlusive crisis.
2. An 18-month-old male is brought to the clinic by his mother. His height is in the
50th percentile, and weight is in the 80th percentile. The child is pale. The physical
examination is normal, but his hematocrit level is 20%. Which of the following
questions should assist the nurse in making a diagnosis? Select all that apply.
1. “How many bowel movements a day does your child have?”
2. “How much did your baby weigh at birth?”
3. “What does your child eat every day?”
4. “Has the child been given any new medications?”
5. “How much milk does your child drink per day?”
3. Which of the following factors need(s) to be included in a teaching plan for a child
with sickle cell anemia? Select all that apply.
1. The child needs to be taken to a physician when sick.
2. The parent should make sure the child sleeps in an air-conditioned room.
3. Emotional stress should be avoided.
4. It is important to keep the child well hydrated.
5. It is important to make sure the child gets adequate nutrition.
4. A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the
following orders should the nurse question? Select all that apply.
1. Position the child for comfort.
2. Apply hot packs to painful areas.
3. Give Demerol 25 mg intravenously every 4 hours as needed for pain.
4. Restrict oral fluids.
5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.
5. A nurse is caring for a child with von Willebrand disease. The nurse is aware that
which of the following is a (are) clinical manifestation(s) of von Willebrand disease?
Select all that apply.
1. Bleeding of the mucous membranes.
2. The child bruises easily.
3. Excessive menstruation.
4. The child has frequent nosebleeds.
5. Elevated creatinine levels.
6. The child has a factor IX deficiency.
6. A child with hemophilia A fell and injured a knee while playing outside. The knee is
swollen and painful. Which of the following measures should be taken to stop the
bleeding? Select all that apply.
1. The extremity should be immobilized.
2. The extremity should be elevated.
3. Warm moist compresses should be applied to decrease pain.
4. Passive range-of-motion exercises should be administered to the extremity.
5. Factor VIII should be administered.
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OR IMMUNOLOGICAL
DISORDERS
7. Which of the following activities should a nurse suggest for a client diagnosed with
hemophilia? Select all that apply.
1. Swimming.
2. Golf.
3. Hiking.
4. Fishing.
5. Soccer.
8. Which of the following describe(s) idiopathic thrombocytopenia purpura (ITP)?
Select all that apply.
1. ITP is a congenital hematological disorder.
2. ITP causes excessive destruction of platelets.
3. Children with ITP have normal bone marrow.
4. Platelets are small in ITP.
5. Purpura is observed in ITP.
9. The nurse is caring for a child who is receiving a transfusion of packed red blood
cells. The nurse is aware that if the child had a hemolytic reaction to the blood, the
signs and symptoms would include which of the following? Select all that apply.
1. Fever.
2. Rash.
3. Oliguria.
4. Hypotension.
5. Chills.
10. The nurse is caring for a child with leukemia. The nurse should be aware that
children being treated for leukemia may experience which of the following
complications? Select all that apply.
1. Anemia.
2. Infection.
3. Bleeding tendencies.
4. Bone deformities.
5. Polycythemia.
11. Which of the following is a (are) reason(s) to do a lumbar puncture on a child with a
diagnosis of leukemia? Select all that apply.
1. Rule out meningitis.
2. Assess the central nervous system for infiltration.
3. Give intrathecal chemotherapy.
4. Determine increased intracranial pressure.
5. Stage the leukemia.
12. Which of the following measures should the nurse implement to help with the
nausea and vomiting from chemotherapy? Select all that apply.
1. Give an antiemetic 30 minutes prior to the start of therapy.
2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is
complete.
3. Remove food that has a lot of odor.
4. Keep the child on a nothing-by-mouth status.
5. Wait until the nausea begins to start the antiemetic.
13. Which of the following can be manifestations of leukemia in a child? Select all
that apply.
1. Leg pain.
2. Fever.
3. Excessive weight gain.
4. Bruising.
5. Enlarged lymph nodes.
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14. Which of the following can lead to a possible diagnosis of human immunodeficiency
virus (HIV) in a child? Select all that apply.
1. Repeated respiratory infections.
2. Intermittent diarrhea.
3. Excessive weight gain.
4. Irregular heartbeat.
5. Poor weight gain.
15. A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin
lymphoma. Which of the following should the nurse include in teaching the parents
about this lymphoma? Select all that apply.
1. The malignancy originates in the lymphoid system.
2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic.
3. Mediastinal involvement is typical.
4. The disease is diffuse rather than nodular.
5. Treatment includes chemotherapy and radiation.
16. A child diagnosed with HIV is prescribed a combination of antiretroviral drugs to
delay ______________________.
17. The nurse is caring for a child with sickle cell disease who is scheduled to have a
splenectomy. What information should the nurse explain to the parents regarding the
reason for a splenectomy?
1. To decrease potential for infection.
2. To prevent splenic sequestration.
3. To prevent sickling of red blood cells.
4. To prevent sickle cell crisis.
18. Which of the following analgesics is most effective for a child with sickle cell
pain crisis?
1. Demerol.
2. Aspirin.
3. Morphine.
4. Excedrin.
19. The nurse is caring for a child with sickle cell anemia who is scheduled to have an
exchange transfusion. What information should the nurse teach the family?
1. The procedure is done to prevent further sickling during a vaso-occlusive crisis.
2. The procedure reduces side effects from blood transfusions.
3. The procedure is a routine treatment for sickle cell crisis.
4. Once the child’s spleen is removed, it is necessary to do exchange transfusions.
20. A nurse instructs the parent of a child with sickle cell anemia about factors that might
precipitate a pain crisis in the child. Which of the following factors identified by the
parent as being able to cause a pain crisis indicates a need for further instruction?
1. Infection.
2. Overhydration.
3. Stress at school.
4. Cold environment.
21. A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is
brought to the ER. The nurse should prepare which of the following?
1. An IM injection of factor VIII.
2. An IV infusion of factor VIII.
3. An injection of desmopressin.
4. An IV infusion of platelets.
22. Which of the following will be abnormal in a child with the diagnosis of hemophilia?
1. Platelet count.
2. Hemoglobin level.
3. White blood cell count.
4. Partial thromboplastin time.
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OR IMMUNOLOGICAL
DISORDERS
23. The parent of a child with hemophilia is asking the nurse what caused the
hemophilia. Which is the nurse’s best response?
1. It is an X-linked dominant disorder.
2. It is an X-linked recessive disorder.
3. It is an autosomal dominant disorder.
4. It is an autosomal recessive disorder.
24. Which of the following measures should the nurse teach the parent of a child with
hemophilia to do first if the child sustains an injury to a joint causing bleeding?
1. Give the child a dose of Tylenol.
2. Immobilize the joint, and elevate the extremity.
3. Apply heat to the area.
4. Administer factor per the home-care protocol.
25. Which of the following measures should be implemented for a child with von
Willebrand disease who has a nosebleed?
1. Apply pressure to the nose for at least 10 minutes.
2. Have the child lie supine and quiet.
3. Avoid packing of the nostrils.
4. Encourage the child to swallow frequently.
26. A nurse educator is providing a teaching session for the nursing staff. Which of
the following individuals is at greatest risk for developing beta-thalassemia
(Cooley anemia)?
1. A child of Mediterranean descent.
2. A child of Mexican descent.
3. A child whose mother has chronic anemia.
4. A child who has a low intake of iron.
27. A nurse is doing discharge education with a parent who has a child with
beta-thalassemia (Cooley anemia). The nurse informs the parent that the child
is at risk for which of the following conditions?
1. Hypertrophy of the thyroid.
2. Polycythemia vera.
3. Thrombocytopenia.
4. Chronic hypoxia and iron overload.
28. The nurse is caring for a child diagnosed with thalassemia major who is receiving
the first chelation therapy. What information should the nurse teach the parent
regarding the therapy?
1. Decreases the risk of bleeding.
2. Eliminates excess iron.
3. Prevents further sickling of the red blood cells.
4. Provides an iron supplement.
29. Which of the following should the nurse expect to administer to a child with ITP
and a platelet count of 5000/mm3?
1. Platelets.
2. Intravenous immunoglobulin.
3. Packed red blood cells.
4. White blood cells.
30. Which test provides a definitive diagnosis of aplastic anemia?
1. Complete blood count with differential.
2. Bone marrow aspiration.
3. Serum IgG levels.
4. Basic metabolic panel.
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31. The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child’s platelet count is 20,000/mm3. Based on this
laboratory finding, what information should the nurse provide to the child and
parents?
1. A soft toothbrush should be used for mouth care.
2. Isolation precautions should be started immediately.
3. The child’s vital signs, including blood pressure, should be monitored every
4 hours.
4. All visitors should be discouraged from coming to see the family.
32. A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On
physical examination, the child is pale and has bruising over various areas of the
body. The physician suspects that the child has ALL. The nurse informs the parent
that the diagnosis will be confirmed by which of the following?
1. Lumbar puncture.
2. White blood cell count.
3. Bone marrow aspirate.
4. Bone scan.
33. The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy.
The child is on neutropenic precautions. Friends of the child come to the desk and
ask for a vase for flowers. Which of the following is the best response?
1. “I will get you a special vase that we use on this unit.”
2. “The flowers from your garden are beautiful but should not be placed in the
room at this time.”
3. “As soon as I can wash a vase, I will put the flowers in it and bring it to the
room.”
4. “Get rid of the flowers immediately. You could harm the child.”
34. The nurse is discharging a child who has just received chemotherapy for neuroblastoma.
Which of the following statements made by the child’s parent indicates a need for
additional teaching?
1. “I will inspect the skin often for any lesions.”
2. “I will do mouth care daily and monitor for any mouth sores.”
3. “I will wash my hands before caring for my child.”
4. “I will take a rectal temperature daily and report a temperature greater than 101°F
(38.3°C) immediately to the physician.”
35. Which intervention should be implemented after a bone marrow aspiration?
1. Ask the child to remain in a supine position.
2. Place the child in an upright position for 4 hours.
3. Keep the child nothing by mouth for 6 hours.
4. Administer analgesics as needed for pain.
36. Which of the following should be done to protect the central nervous system from
the invasion of malignant cells in a child newly diagnosed with leukemia?
1. Cranial and spinal radiation.
2. Intravenous steroid therapy.
3. Intrathecal chemotherapy.
4. High-dose intravenous chemotherapy.
37. A child with leukemia is receiving chemotherapy and is complaining of nausea. The
nurse has been giving the scheduled antiemetic. Which of the following should the
nurse do when the child is nauseated?
1. Encourage low-protein foods.
2. Encourage low-caloric foods.
3. Offer the child’s favorite foods.
4. Offer cool, clear liquids.
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38. School-age children with cancer often have a body image disturbance related to hair loss,
moon face, or debilitation. Which of the following interventions is most appropriate?
1. Encourage them to wear a wig similar to their own hairstyle.
2. Emphasize the benefits of the therapy they are receiving.
3. Have them play only with other children with cancer.
4. Use diversional techniques to avoid discussing changes in the body because of the
chemotherapy.
39. The nurse receives a call from a parent of a child with leukemia in remission. The
parent says the child has been exposed to chickenpox. The child has never had
chickenpox. Which of the following responses is most appropriate for the nurse?
1. “You need to monitor the child’s temperature frequently and call back if the
temperature is greater than 101°F (38.3°C).”
2. “At this time there is no need to be concerned.”
3. “You need to bring the child to the clinic for a chickenpox immunoglobulin vaccine.”
4. “Your child will need to be isolated for the next 2 weeks.”
40. The nurse is caring for a child being treated for ALL. Laboratory results indicate that
the child has a white blood cell count of 5000/mm3 with 5% polys and 3% bands.
Which of the following analyses is most appropriate?
1. The absolute neutrophil count is 400/mm3, and the child is neutropenic.
2. The absolute neutrophil count is 800/mm3, and the child is neutropenic.
3. The absolute neutrophil count is 4000/mm3, and the child is not neutropenic
4. The absolute neutrophil count is 5800/mm3, and the child is not neutropenic.
41. Which of the following is the best method to prevent the spread of infection to an
immunosuppressed child?
1. Administer antibiotics prophylactically to the child.
2. Have people wash their hands prior to contact with the child.
3. Assign the same nurses to care for the child each day.
4. Limit visitors to family members only.
42. Which of the following is correct regarding prognostic factors for determining
survival for a child newly diagnosed with ALL?
1. The initial white blood cell count on diagnosis.
2. The race of the child.
3. The amount of time needed to initiate treatment.
4. The allergy history of the child.
43. A child diagnosed with leukemia is receiving allopurinol as part of the treatment
plan. The parents ask why their child is receiving this medication. What information
about the medication should the nurse provide?
1. Helps reduce the uric acid level caused by cell destruction.
2. Used to make the chemotherapy work better.
3. Given to reduce the nausea and vomiting associated with chemotherapy.
4. Helps decrease pain in the bone marrow.
44. Prednisone is given to children who are being treated for leukemia. Why is this
medication given as part of the treatment plan?
1. Enhances protein metabolism.
2. Enhances sodium excretion.
3. Increases absorption of the chemotherapy.
4. Destroys abnormal lymphocytes.
45. Which of the following best describes the action of chemotherapeutic agents used in
the treatment of cancer in children?
1. Suppress the function of normal lymphocytes in the immune system.
2. Are alkylating agents and are cell-specific.
3. Cause a replication of DNA and are cell-specific.
4. Interrupt cell cycle, thereby causing cell death.
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46. A child has completed treatment for leukemia and comes to the clinic with the
parents for a checkup. The parents express to the nurse that they are glad their child
has been cured of cancer and is safe from getting cancer later in life. Which of the
following should the nurse consider in responding?
1. Childhood cancer usually instills immunity to all other cancers.
2. Children surviving one cancer are at higher risk for a second cancer.
3. The child may have a remission of the leukemia but is immune to all other cancers.
4. As long as the child continues to take steroids, there will be no other cancers.
47. A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is
aware that which of the following symptoms should make the physicians suspect
Hodgkin disease?
1. Fever, fatigue, and pain in the joints.
2. Anorexia with weight loss.
3. Enlarged, painless, and movable lymph nodes in the cervical area.
4. Enlarged liver with jaundice.
48. Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old?
1. Reed-Sternberg cells in the lymph nodes.
2. Blast cells in the blood.
3. Lymphocytes in the bone marrow.
4. VMA in the urine.
49. The parent of a teen with a diagnosis of Hodgkin disease asks what the child’s
prognosis will be with treatment. What information should the nurse give to the
parent and child?
1. Clinical staging of Hodgkin disease will determine the treatment; long-term
survival for all stages of Hodgkin disease is excellent.
2. There is a considerably better prognosis if the client is diagnosed early and is
between the ages of 5 and 11 years.
3. The prognosis for Hodgkin disease depends on the type of chemotherapy.
4. The only way to obtain a good prognosis is by chemotherapy and bone marrow
transplant.
50. The nurse is caring for a child who is receiving extensive radiation as part of the
treatment for Hodgkin disease. Which intervention should be implemented?
1. Administer pain medication prior to the child’s going to radiation therapy.
2. Assess the child for neuropathy since this is a common side effect.
3. Provide adequate rest, as the child may experience excessive malaise and lack of
energy.
4. Encourage the child to eat a low-protein diet while on radiation therapy.
51. The parent of a 4-year-old brings the child to the clinic and tells the nurse the child’s
abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on
this child?
1. Avoid palpation of the abdomen.
2. Assess the urine for the presence of blood.
3. Monitor vital signs, especially the blood pressure.
4. Obtain an accurate height and weight.
52. The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment
plan will be. The nurse explains the usual protocol for this condition. Which
information should the nurse give to the parent?
1. The child will have chemotherapy and, after that has been completed, radiation.
2. The child will need to have surgery to remove the tumor.
3. The child will go to surgery for removal of the tumor and the kidney and will
then start chemotherapy.
4. The child will need radiation and later surgery to remove the tumor.
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53. The nurse expects which of the following clinical manifestations in a child diagnosed
with SCID?
1. Prolonged bleeding.
2. Failure to thrive.
3. Fatigue and malaise.
4. Susceptibility to infection.
54. What are the clinical manifestations of non-Hodgkin lymphoma?
1. Basically the same as those in Hodgkin disease.
2. Depends on the anatomical site and extent of involvement.
3. Those that affect the abdomen, as non-Hodgkin lymphoma is a fast-growing
cancer in very young children.
4. Changes that occur in the lower extremities.
55. When caring for a child with lymphoma, the nurse needs to be aware of which of the
following?
1. The same staging system is used for lymphoma and Hodgkin disease.
2. The aggressive chemotherapy with central nervous system prophylaxis will give
the child a good prognosis.
3. All children with lymphoma need a bone marrow transplant for a good prognosis.
4. Despite high-dose chemotherapy, the prognosis is very poor for most children
with a diagnosis of lymphoma.
56. Where is the primary site of origin of the tumor in children who have neuroblastoma?
1. Bone.
2. Kidney.
3. Abdomen.
4. Liver.
57. Which of the following is the most common opportunistic infection in children
infected with human immunodeficiency virus (HIV)?
1. CMV.
2. Encephalitis.
3. Meningitis.
4. Pneumocystic pneumonia.
58. Which of the following laboratory tests will be ordered to determine the presence of
the human immunodeficiency virus antigen in an infant whose parent is HIV+?
1. CD4 cell count.
2. Western blot.
3. IgG levels.
4. p24 antigen assay.
59. The nurse is instructing the parent of a child with HIV about immunizations. Which
of the following should the nurse tell the parent?
1. Hepatitis B vaccine will not be given to this child.
2. Members of the family should be cautioned not to receive the varicella vaccine.
3. The child will need to have a Western blot test done prior to all immunizations.
4. Pneumococcal and influenza vaccines are recommended.
60. The parent of a 2-year-old who is HIV+ questions the nurse about placing the child
in day care. Which of the following is the best response?
1. The child should not go to day care until older, because there is a high risk for
transmission of the disease.
2. The child can be admitted to day care without restrictions and should be allowed
to participate in all activities.
3. The child can go to day care but should avoid physical activity.
4. The child may go to day care, but the parent must inform all the parents at the
day care that the child is HIV+.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 3, 5, 6.
1. Polycythemia is seen in children with
chronic hypoxia, such as cyanotic heart
disease.
2. Hemarthrosis is commonly seen in children
with hemophilia.
3. Aplastic crisis is associated with sickle
cell anemia.
4. Thrombocytopenia is associated with
idiopathic thrombocytopenia purpura.
5. Splenic sequestration is associated with
sickle cell anemia.
6. Vaso-occlusive crisis is the most common problem in children with sickle cell
disease.
TEST-TAKING HINT: Review the definition
of terms. That will eliminate the other
choices.
2. 3, 5.
1. Because the child has a low hematocrit
level, the child most likely has anemia.
Iron-deficiency anemia is the most common
nutritional anemia. The number of bowel
movements the child has is important
information but not necessary to make the
diagnosis of iron-deficiency anemia.
2. Knowing birth weight can help determine if
the child is following his or her own curve
on the growth chart.
3. A diet history is necessary to determine
the nutritional status of the child and
whether the child is getting sufficient
sources of iron.
4. Knowing if the child is taking any new medication is good but is not necessary to make
the diagnosis of iron-deficiency anemia.
5. By asking how much milk the child consumes, the nurse can determine whether
the child is filling up on milk and then
not wanting to take food.
TEST-TAKING HINT: The most common
anemia in children and in toddlers is irondeficiency anemia, frequently due to
drinking too much milk and not eating
enough iron-rich foods
3. 1, 3, 4, 5.
1. Seek medical attention for illness to
prevent the child from going into a crisis.
124
2. A cold environment causes vasoconstriction,
which needs to be prevented to get good
tissue perfusion.
3. Stress can cause a depressed immune
system, making the child more susceptible to infection and crisis. Parents and
children are advised to avoid stress.
4. The child needs good hydration and
nutrition to maintain good health.
5. The child needs good hydration and
nutrition to maintain good health.
TEST-TAKING HINT: Focus on how to
prevent a sickle cell crisis.
4. 3, 4.
1. Medical treatment of sickle cell crises is
directed toward preventing hypoxia. Tissue
hypoxia is very painful, so placing the child
in a position of comfort is important.
2. Hot packs help relieve pain because they
cause vasodilation, which allows increased
blood flow and decreased hypoxia.
3. Tissue hypoxia is very painful. Narcotics
such as morphine are usually given
for pain when the child is in a crisis.
Demerol should be avoided because of
the risk of Demerol-induced seizures.
4. The child should receive hydration
because when the child is in crisis, the
abnormal S-shaped red blood cells
clump, causing tissue hypoxia and pain.
5. Providing oxygen when the oxygen saturation decreases helps treat the hypoxia.
TEST-TAKING HINT: Focus on the pathophysiology of a vaso-occlusive crisis. Keep
in mind measures that decrease tissue
hypoxia.
5. 1, 2, 3, 4.
1. Von Willebrand disease is a hereditary
bleeding disorder characterized by deficiency of or defect in a protein. The disorder causes adherence of platelets to
damaged endothelium and a mild deficiency of factor VIII. One of the manifestations of this disease is bleeding of
the mucous membranes.
2. Bruising is a common manifestation of
this disease.
3. Excessive menstruation may be a manifestation of this disease.
4. Frequent nosebleeds are a common
manifestation of this disease.
5. There is no increase in creatinine in this
disease.
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6. Von Willebrand disease is a mild factor
VIII deficiency, not a factor IX deficiency.
TEST-TAKING HINT: Focus on the diagnosis.
Von Willebrand disease is a minor deficiency
of factor VIII, so the clinical manifestations
will be less severe.
6. 1, 2, 5.
1. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity.
2. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment
should include elevating the extremity.
3. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment
should include an application of cold
compression.
4. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment
should include factor replacement.
5. Hemophilia A is a deficiency in factor
VIII, which causes delay in clotting when
there is a bleed.
TEST-TAKING HINT: Focus on the disease
process and measures to stop bleeding.
7. 1, 2, 3, 4.
1. Children with hemophilia should be
encouraged to take part in noncontact
activities that allow for social, psychological, and physical growth, such as
swimming.
2. Children with hemophilia should be
encouraged to take part in noncontact
activities that allow for social, psychological, and physical growth, such as golf.
3. Children with hemophilia should be
encouraged to take part in noncontact
activities that allow for social, psychological, and physical growth, such
as hiking.
4. Children with hemophilia should be
encouraged to take part in noncontact
activities that allow for social, psychological, and physical growth, such as fishing.
5. Contact sports like soccer should be
discouraged.
TEST-TAKING HINT: Soccer is the only contact sport listed, so the other answers can
be selected.
8. 2, 3, 5.
1. ITP is an acquired hematological condition
that is characterized by excessive destruction of platelets, purpura, and normal bone
marrow along with an increase in large,
yellow platelets.
OR IMMUNOLOGICAL
DISORDERS
2. ITP is characterized by excessive
destruction of platelets.
3. The bone marrow is normal in
children with ITP.
4. Platelets are large, not small.
5. ITP is characterized by purpuras,
which are areas of hemorrhage under
the skin.
TEST-TAKING HINT: Review the pathophysiology of ITP to determine the manifestations of the disease.
9. 1, 3, 4.
1. Hemolytic reactions include fever, pain
at insertion site, hypotension, renal
failure, tachycardia, oliguria, and
shock.
2. Febrile reactions are fever and chills.
Allergic reactions include hives, itching,
and respiratory distress.
3. Hemolytic reactions include fever, pain
at insertion site, hypotension, renal
failure, tachycardia, oliguria, and
shock.
4. Hemolytic reactions include fever, pain
at insertion site, hypotension, renal
failure, tachycardia, oliguria, and
shock.
5. Febrile reactions are fever and rash.
Allergic reactions include rash, hives,
and respiratory distress.
TEST-TAKING HINT: Review the signs and
symptoms of hemolytic reaction, febrile
reaction, and allergic reaction. Understanding the causes of the reactions will
help identify the symptoms.
10. 1, 2.
1. Anemia is caused by decreased production of red blood cells.
2. Infection risk in leukemia is secondary
to the neutropenia.
3. Bleeding tendencies are from decreased
platelet production.
4. There are no bone deformities with
leukemia, but there is bone pain from the
proliferation of cells in the bone marrow.
5. Polycythemia is an increase in red blood
cells.
TEST-TAKING HINT: Review the pathophysiology of leukemia to determine the
clinical problems.
11. 2, 3.
1. There is no need to do a spinal tap to rule
out meningitis unless the patient has
symptoms of meningitis.
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2. A lumbar puncture is done to assess
the central nervous system by obtaining a specimen that can determine the
presence of leukemic cells.
3. Chemotherapy can also be given with
a spinal tap.
4. There should not be an indication to
determine increased intracranial pressure.
5. Leukemia is not staged.
TEST-TAKING HINT: Review the central
nervous system involvement with leukemia.
12. 1, 2, 3.
1. The first dose should be given
30 minutes prior to the start of
the therapy.
2. Antiemetic should be administered
around the clock until 24 hours after
the chemotherapy is completed.
3. It is also helpful to remove foods with
odor so the smell of the food does not
make the child nauseated.
4. The child should be allowed to take food
and fluids as tolerated.
5. Antiemetics are most beneficial if
given before the onset of nausea and
vomiting.
TEST-TAKING HINT: Review measures to
prevent nausea and vomiting.
13. 1, 2, 4, 5.
1. The proliferation of cells in the bone
marrow can cause leg pain.
2. Fever is a result of the neutropenia.
3. There is usually a decrease in weight,
because the child will feel sick and not
as hungry.
4. A decrease in platelets causes the
bruising.
5. The lymph nodes are enlarged from
the infiltration of leukemic cells.
TEST-TAKING HINT: Review the consequences of depressed bone marrow, and
relate them to the clinical manifestations.
14. 1, 2, 5.
1. Symptoms of human immunodeficiency virus include frequent respiratory infections. The symptoms present
based on the underlying cellular
immunodeficiency-related disease.
2. Symptoms of human immunodeficiency virus include intermittent
diarrhea. The symptoms present
based on the underlying cellular
immunodeficiency-related disease.
3. Symptoms of human immunodeficiency
virus include poor weight gain. The
symptoms present based on the underlying
cellular immunodeficiency-related disease.
4. Irregular heart rate is not associated with
human immunodeficiency virus.
5. Symptoms of human immunodeficiency virus include poor weight gain.
TEST-TAKING HINT: Review symptoms of
HIV that should lead to a differential
diagnosis.
15. 1, 3, 4, 5.
1. Non-Hodgkin disease originates in the
lymphoid system.
2. Reed-Sternberg cells are diagnostic for
Hodgkin disease.
3. Mediastinal involvement is typical.
4. The disease is diffuse rather than
nodular.
5. Treatment includes chemotherapy and
radiation.
TEST-TAKING HINT: Identify the differences
between non-Hodgkin lymphoma and
Hodgkin disease.
16. Drug resistance.
A combination of antiretroviral medications
is prescribed for a child who is HIV positive
to delay develoment of drug resisitance.
HIV drugs work on different stages of the
HIV life cycle to prevent reproduction of
new virus particles.
TEST-TAKING HINT: The test taker understands the use of antiretroviral medications.
17. 1. The cells involved with sickle cell anemia
are red blood cells, so a decrease in
infection would not be correct.
2. Splenic sequestration is a lifethreatening situation in children with
sickle cell anemia. Once a child is
considered to be at high risk of splenic
sequestration or has had this in the
past, the spleen will be removed.
3. Removal of the spleen will not prevent
sickling, as it will not change the disease
condition.
4. The child will still have sickle cell disease
and can still have sickle cell crises.
TEST-TAKING HINT: Review splenic sequestration and when a child can go into sickle
cell crisis.
18. 1. Demerol should not be used as it may
potentiate seizures.
2. Aspirin should not be used in children
because of the risk for Reye syndrome.
3. Morphine is the drug of choice for a
child with sickle cell crises. Usually the
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OR IMMUNOLOGICAL
DISORDERS
child is started on oral doses of Tylenol
with codeine. When that is not sufficient
to alleviate pain, stronger narcotics are
prescribed such as morphine.
4. Excedrin contains aspirin.
TEST-TAKING HINT: One needs to consider
using narcotics when a child has sickle
cell crises, as tissue hypoxia can cause
severe pain.
3. The white blood cell count does not
change with hemophilia.
4. The abnormal laboratory results in
hemophilia are related to decreased
clotting function. Partial thromboplastin
time is prolonged.
TEST-TAKING HINT: Use the process of
elimination to determine the test that
indicates a decrease in clotting.
19. 1. Exchange transfusion reduces the
number of circulating sickle cells and
slows down the cycle of hypoxia,
thrombosis, and tissue ischemia.
2. Exchange transfusion does not decrease
risk of a transfusion reaction. Every time
a transfusion is done, the child continues
to be at risk for a reaction.
3. This is not a routine procedure and is
performed only when the number of
sickle cells is elevated and the child is at
high risk for thrombosis.
4. After a splenectomy, transfusions still
need to be done depending on the client’s
hemoglobin level.
TEST-TAKING HINT: Consider the reasons
transfusions are given with sickle cell
clients.
23. 1. Hemophilia is transmitted as an X-linked
recessive disorder. About 60% of children
have a family history of hemophilia. The
usual transmission is by a female with the
trait and an unaffected male.
2. Hemophilia is transmitted as an
X-linked recessive disorder. About
60% of children have a family history
of hemophilia. The usual transmission
is by a female with the trait and an
unaffected male.
3. Hemophilia is transmitted as an
X-linked recessive disorder. About
60% of children have a family history
of hemophilia. The usual transmission
is by a female with the trait and an
unaffected male.
4. Hemophilia is transmitted as an X-linked
recessive disorder. About 60% of children
have a family history of hemophilia. The
usual transmission is by a female with the
trait and an unaffected male.
TEST-TAKING HINT: The test taker needs to
know how hemophilia is transmitted.
20. 1. An infection can cause a child to go into
crisis.
2. Overhydration does not cause a crisis.
3. Emotional stress can cause a child to go
into crisis.
4. A cold environment causes vasoconstriction,
which could lead to crisis.
TEST-TAKING HINT: Because sickle cell
anemia may be precipitated by infection,
dehydration, trauma, hypoxia, or stress,
use the process of elimination to determine the need for further instruction.
21. 1. Factor VIII is not given intramuscularly.
2. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding.
3. Desmopressin is given to stimulate
factor VIII production, and it is given
intravenously.
4. Platelets are not affected in hemophilia.
TEST-TAKING HINT: Focus on the diagnosis
of hemophilia: a deficiency in factor VIII
causes continued bleeding with an injury.
24. 1. Tylenol helps with the pain but does not
stop the bleeding.
2. Elevating and immobilizing the extremity
are good interventions as they decrease
blood flow. Factor should be administered
first, however.
3. Cold, not heat, should be applied to
promote vasoconstriction.
4. Administration of factor should be
the first intervention if home-care
transfusions have been initiated.
TEST-TAKING HINT: Treatment of hemophilia is to provide factor replacement as
soon as possible after a bleed has started.
Application of cold, elevation of extremities, and application of pressure for 10 to
15 minutes are all good interventions
after the factor is given.
22. 1. Platelet function is normal in hemophilia.
2. There is no change in hemoglobin with a
diagnosis of hemophilia. The hemoglobin
will drop with bleeding.
25. 1. Applying pressure to the nose may
stop the bleeding. In von Willebrand
disease, there is an increased tendency
to bleed from mucous membranes,
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leading to nosebleeds commonly from
the anterior part of the nasal septum.
2. The child should sit up and lean forward
to avoid aspiration of blood.
3. Packing the nose with cotton may be used
to stop bleeding, but be careful when
the cotton is removed as it may dislodge
the clot.
4. Swallowing will cause the child to swallow
the blood, which then can cause vomiting.
TEST-TAKING HINT: Focus on the most
common areas of bleeding in von
Willebrand disease and on how to
treat the bleeding.
26. 1. Beta-thalassemia is an inherited recessive disorder that is found primarily in
individuals of Mediterranean descent.
The disease has also been reported in
Asian and African populations.
2. It is not found often in the Mexican
population.
3. This is a hereditary disease that causes
chronic anemia. The mother should have
had thalassemia for this answer to be
correct.
4. This disorder has nothing to do with iron
deficiency.
TEST-TAKING HINT: Use the process of
elimination, knowing that the disorder
is a hereditary disorder in those of
Mediterranean descent.
27. 1. The thyroid is not involved in betathalassemia.
2. Polycythemia vera refers to excessive red
blood cell production, which can result in
thrombosis.
3. There is no increase in platelets in betathalassemia.
4. In beta-thalassemia there is increased
destruction of red blood cells, causing
anemia. This results in chronic anemia
and hypoxia. The children are treated
with multiple blood transfusions,
which can cause iron overload and
damage to major organs.
TEST-TAKING HINT: Focus on the pathophysiology of the disease. Then, by
process of elimination, the effect of the
disease on the body can be identified.
28. 1. There are no bleeding tendencies in
thalassemia major (beta-thalassemia or
Cooley anemia), and chelation does not
affect clotting.
2. Chelation therapy is used to rid the
body of excess iron stores that result
from frequent blood transfusions.
3. There is no sickling of red blood cells in
thalassemia, and chelation therapy has no
direct effect on red blood cells.
4. Chelation does not provide an iron
supplement.
TEST-TAKING HINT: Focus on the treatment of beta-thalassemia and how
chelation therapy works.
29. 1. In ITP, destruction of platelets is caused
from what is believed to be an immune
response, so giving additional platelets
would only result in new platelets being
destroyed.
2. Intravenous immunoglobulin is given
because the cause of platelet destruction is believed to be an autoimmune
response to disease-related antigens.
Treatment is usually supportive.
Activity is restricted at the onset
because of the low platelet count
and risk for injury that could cause
bleeding.
3. Red blood cells are not an effective
treatment for ITP.
4. White blood cells are not an effective
treatment for ITP. White blood cell
infusion is rarely done with any disease
process.
TEST-TAKING HINT: Focus on the cause of
ITP and which cells are affected.
30. 1. A complete blood count with differential
indicates pancytopenia but does not
reveal what is occurring in the bone
marrow.
2. Definitive diagnosis is determined
from bone marrow aspiration, which
demonstrates the conversion of red
bone marrow to yellow, fatty marrow.
3. Serum IgG levels do not diagnose aplastic
anemia, which does not seem to have an
immune cause.
4. A basic metabolic panel tests for metabolic disorders.
TEST-TAKING HINT: Focus on the fact that
aplastic anemia is a failure in the bone
marrow that causes pancytopenia, so
analysis of the bone marrow would
confirm the diagnosis.
31. 1. Because the platelet count is decreased, there is a significant risk
of bleeding, especially in soft tissue.
The use of the soft toothbrush
should help prevent bleeding of
the gums.
2. A low platelet count does not indicate a
need to start isolation.
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CHAPTER 7 HEMATOLOGICAL
3. There is always a need to monitor the
child frequently, but the low platelet
count puts the child at risk for bleeding.
4. In caring for children, always screen
visitors, but there is no need to restrict
visitation unless something is found on
the screening.
TEST-TAKING HINT: Identify that the platelet
count is low and can cause bleeding. The
plan of care should include measures to
protect the child from bleeding.
32. 1. A lumbar puncture is done to look for
blast cells in the spinal fluid, which indicate central nervous system disease. It is
also done to administer intrathecal
chemotherapy, as the chemotherapy that
will be given does not pass through the
blood–brain barrier.
2. An altered white blood cell count occurs
as a result of the disease, but it does not
make the diagnosis, as many diseases can
alter the white blood cell count.
3. The diagnostic test that confirms
leukemia is microscopic examination
of the bone marrow aspirate.
4. Bone scans do not confirm the diagnosis of
a disease that occurs in the bone marrow.
TEST-TAKING HINT: The key to answering
this question is the phrase “diagnosis will
be confirmed.”
33. 1. Flowers should not be kept in the room
of the client who is neutropenic. There
are no special vases that are used with
these clients that can protect them from
infection.
2. A neutropenic client should not have
flowers in the room because the
flowers may harbor Aspergillus or
Pseudomonas aeruginosa. Neutropenic
children are susceptible to infection.
Precautions need to be taken so the
child does not come in contact with
any potential sources of infection.
Fresh fruits and vegetables can also
harbor molds and should be avoided.
Telling the friend that the flowers are
beautiful but that the child cannot
have them is a tactful way not to
offend the friend.
3. Washing the vase will not change the reason
for not having the flowers around the child.
4. This could scare the visitors and make
them feel guilty that they might harm the
child in some way.
TEST-TAKING HINT: Review neutropenic
precautions; then by process of elimination
OR IMMUNOLOGICAL
DISORDERS
determine that answers 1 and 3 are incorrect. Answer 4 is not a professional way of
interacting with visitors.
34. 1. Inspecting the skin is a good measure to
monitor for infection and should be done.
2. Mouth care is essential and should be
done daily to help prevent infection.
Chemotherapy puts the child at risk for
mucositis.
3. Washing the hands is one of the most
important measures to prevent infection.
4. Monitoring the child’s temperature
and reporting it to the physician
are important, but the temperature
should not be taken rectally. The risk
of injury to the mucous membranes
is high. Rectal abscesses can occur in
the damaged rectal tissue. The best
method of taking the temperature is
axillary, especially if the child has
mouth sores.
TEST-TAKING HINT: Review home-care
instructions for children who have just
received chemotherapy. These are
measures to protect the child from
infection and to monitor for infection.
35. 1. There is no need to have the client
remain supine after a bone marrow
aspiration is done.
2. The child can assume any position after a
bone marrow aspiration.
3. The child usually receives conscious
sedation during the procedure and will
have nothing by mouth prior to the
procedure. Oral fluids can be resumed
after the procedure is completed.
4. Children may experience minor
discomfort after the procedure, and
analgesics should be given as needed.
TEST-TAKING HINT: Review the procedure
for doing a bone marrow aspiration, and
be aware of nursing care after the procedure. There should be no reason for the
child to be in a specific position or to have
fluids withheld after the procedure.
Managing pain is always a priority need.
36. 1. Radiation should be done as part of therapy if there is metastasis.
2. Steroids are given as part of the treatment
protocol but do not need to be given intravenously. Steroids do not pass through
the blood–brain barrier.
3. Giving chemotherapy via lumbar puncture allows the drugs to get to the
brain and helps prevent metastasis of
the disease.
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PEDIATRIC SUCCESS
4. Chemotherapy that is given intravenously
will not pass through the blood–brain
barrier.
TEST-TAKING HINT: Chemotherapy does
not pass through the blood–brain barrier.
Intrathecal chemotherapy needs to be
done to protect the central nervous
system from metastasis of the disease.
37. 1. It is better to provide high-protein
nutritional supplements if the child can
tolerate them.
2. It is better to provide high-caloric
nutritional supplements.
3. Offering the child’s favorite foods when
the child is nauseated can create a later
association with being sick; then the child
may not want that food when not ill.
4. Cool, clear liquids are better tolerated.
Milk-based products cause secretions
to be thick and can cause vomiting.
TEST-TAKING HINT: With nausea and vomiting, it is important to consider nutritional
status. Answers 1 and 2 do not improve
nutrition. Supportive nutritional supplements should be offered. Review measures
to prevent nausea and provide nutrition.
38. 1. Wearing a wig is a good way for the
child to keep personal identity despite
the loss of hair.
2. Just discussing the benefits of the therapy
will not help the child with self-image.
3. Having the child play only with other
children with cancer could make the child
feel even worse because of the inability
to interact with friends. The child needs
to find acceptance as appearance begins to
change.
4. Diverting the child’s attention would be
avoiding the truth and would not be
dealing with the issues.
TEST-TAKING HINT: Review the side effects
on the body from the chemotherapy, and
look at ways to help the child deal with
body-image changes. Provide the child
and family with accurate information of
the side effects of the drugs, but also give
the child ways to feel good.
39. 1. The temperature should always be monitored, but the child has been exposed to
chickenpox. The child needs to be
protected from getting the disease as
it can be life threatening.
2. Chickenpox exposure is a real concern for
a child who is immunocompromised, and
action needs to be taken.
3. The child should receive varicella
zoster immune globulin within
96 hours of the exposure.
4. Starting isolation at this time does not
protect the child.
TEST-TAKING HINT: Review protective
precautions that should be utilized for
immunocompromised children. Chickenpox can be deadly for these children.
40. 1. The calculated absolute neutrophil
count is 400/mm3 (0.08 × 5000) and is
neutropenic as it is less than 500/mm3.
2. The absolute neutrophil count is incorrectly calculated. The child would not be
neutropenic with a count of 800/mm3.
3. The absolute neutrophil count is incorrectly calculated. The child would not be
neutropenic with a count of 4000/mm3.
4. The absolute neutrophil count is incorrectly calculated. The child would not be
neutropenic if the count were 5800/mm3.
TEST-TAKING HINT: To calculate the
absolute neutrophil count, multiply the
white blood cell count by the percentage
of neutrophils (“polys,” “segs,” and
“bands”). For example: WBC = 1500/mm3,
neutrophils = 7%, nonsegmented neutrophils (bands) = 7%. 7% + 7% = 14%.
0.14 × 1500 = 210/mm3 ANC. Precautions
for infection should be used at all times
with children who are immunosuppressed,
but greater precautions must be taken
when the ANC is less than 500/mm3.
41. 1. Antibiotics should be used only if the
child has a bacterial infection.
2. Hand-washing is the best method to
prevent the spread of germs and
protect the child from infection.
3. All nurses should use the same techniques
in caring for the child. Assigning the same
nurses may not be possible.
4. Visitors should be screened for infection
and communicable diseases, but visitors
should not be limited to family
members only.
TEST-TAKING HINT: The first defense
against infection is prevention. Strict
hand-washing technique is a primary
intervention to prevent the spread of
infections. Review measures to protect
the child from infection.
42. 1. Children with a normal or low white
blood cell count who do not have
non-T, non-B acute lymphoblastic
leukemia, and who are CALLA-positive
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have a much better prognosis than
those with high cell counts or other
cell types.
2. Race is not a factor in prognosis of
leukemia.
3. The child should begin treatment as soon
as diagnosed, but time in initiating treatment does not have an effect on prognosis.
4. A history of allergies has no connection to
prognosis in acute lymphoblastic leukemia.
TEST-TAKING HINT: Review the important
prognostic factors that affect long-term survival for children with acute lymphoblastic
leukemia.
43. 1. Allopurinol reduces serum uric acid.
When there is lysis of cells from
chemotherapy, there will be an increase in serum uric acid.
2. There is no specific medication that
makes chemotherapy work better.
3. Allopurinol is not an antiemetic.
4. Allopurinol is not an analgesic.
TEST-TAKING HINT: Review the effects of
the tumor lysis syndrome that occurs
when chemotherapy is started with
children with leukemia.
44. 1. Prednisone does not enhance protein
metabolism.
2. Prednisone may cause retention of sodium.
3. There is no drug that increases
absorption of chemotherapy.
4. Prednisone is used in many of the
treatment protocols for leukemia
because there is abnormal lymphocyte
production. Prednisone is thought to
destroy abnormal lymphocytes.
TEST-TAKING HINT: Prednisone is given in
conjunction with chemotherapy. It helps
modify the body’s immune response.
45. 1. All chemotherapy is immunosuppressive as most childhood cancers affect
the immune system.
2. Not all chemotherapy drugs are alkylating
agents.
3. There is no replication of DNA with
chemotherapy. Chemotherapy drugs such
as the antimetabolites usually inhibit synthesis of DNA or RNA.
4. There is no interruption of the cell cycle.
TEST-TAKING HINT: Review the function of
each type of chemotherapeutic agent
because the immune system is affected
in childhood cancer.
46. 1. There is no immunity to recurrent
cancers with remission of the leukemia.
OR IMMUNOLOGICAL
DISORDERS
2. The most devastating late effect of
leukemia treatment is development of
secondary malignancy.
3. After the child is in remission, the child
may relapse, but there is no immunity to
other malignancy.
4. The child will not receive steroid
treatment after completing therapy.
TEST-TAKING HINT: Review late effects of
treatment of childhood cancer. This
should include chemotherapy as well as
radiation treatments.
47. 1. Fever and pain may be some of the symptoms, but they can be from other forms of
cancer. Joint pain is not a symptom of
Hodgkin disease.
2. Anorexia with weight loss can be a
symptom of many other conditions.
3. Enlarged, painless, and movable lymph
nodes in the cervical area are the most
common presenting manifestations of
Hodgkin disease.
4. Enlarged liver with jaundice is not a presenting symptom with Hodgkin disease.
TEST-TAKING HINT: Review the clinical
manifestations of Hodgkin disease. Some
of the manifestations are the same for
many different cancers, so focus on the
primary and most common manifestations.
48. 1. A lymph node biopsy is done to confirm a histological diagnosis and
staging of Hodgkin disease. The
presence of Reed-Sternberg cells is
characteristic of the disease.
2. Blast cells are usually seen with leukemia.
3. A bone marrow aspiration is usually done
to diagnose the type of leukemia.
4. This test is done to diagnose
neuroblastoma.
TEST-TAKING HINT: In reviewing Hodgkin
disease, be aware of the specific cell identified to confirm diagnosis.
49. 1. Long-term survival for all stages of
Hodgkin disease is excellent. Earlystage disease can have a survival rate
greater than 90%, with advanced stages
having rates between 65% and 75%.
2. Hodgkin disease mostly affects adolescents.
3. The treatment consists of chemotherapy
and often radiation therapy and does not
predict prognosis.
4. Bone marrow transplant is not always
necessary with the treatment of Hodgkin
disease and will most likely worsen the
prognosis.
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PEDIATRIC SUCCESS
TEST-TAKING HINT: Know the treatment
and the prognosis of Hodgkin disease.
50. 1. It should not be necessary to give pain
medication, as radiation therapy should
not be painful.
2. Neuropathy is not a normal side effect
of radiation therapy.
3. The most common side effect is
extensive malaise, which may be from
damage to the thyroid gland, causing
hypothyroidism.
4. No diet restriction is required for the
radiation therapy. Continue with nutritional supplements as needed to maintain
adequate nutrition.
TEST-TAKING HINT: Review the side
effects of radiation therapy. Lack of
energy may be difficult emotionally in
adolescents, as they want to keep up
with their peers.
51. 1. Palpating the abdomen of the child in
whom a diagnosis of Wilms tumor is
suspected should be avoided, because
manipulation of the abdomen may
cause seeding of the tumor.
2. Hematuria is a clinical manifestation.
3. Because the kidney is involved,
hypertension should be assessed.
4. Height and weight are always important
to obtain, as they can be used to calculate
doses of medications and chemotherapy.
TEST-TAKING HINT: All of the assessment
data are important, but the key phrase is
“most important.” Seeding of the tumor
could spread cancerous cells.
52. 1. Chemotherapy is started after tumor
removal, and radiation is done depending
on stage and histological pattern.
2. Combination therapy of surgery and
chemotherapy is the therapeutic management.
3. Combination therapy of surgery and
chemotherapy is the primary therapeutic management. Radiation is done
depending on clinical stage and
histological pattern.
4. Radiation should be done after surgery
and chemotherapy, depending on stage
and histological pattern.
TEST-TAKING HINT: Staging and biopsy
determine the treatment, but the child
will always have the tumor and kidney
removed, followed by chemotherapy.
53. 1. Prolonged bleeding indicates abnormalities
of the clotting system.
2. Failure to thrive is a consequence of a
present illness.
3. Fatigue and malaise result from decreases
in red blood cells.
4. SCID is characterized by an absence of
cell-mediated immunity, with the most
common clinical manifestation being infection in children from age 3 months.
These children do not usually recover
from these infections.
TEST-TAKING HINT: Review the clinical
manifestations of SCID, keeping in mind
that the word “immunodeficiency” should
indicate infection, which is the key to
getting the correct answer.
54. 1. The clinical manifestations are different
from those of Hodgkin disease, as the enlarged lymph nodes usually occur in the
cervical area.
2. The clinical manifestations include
symptoms of involvement. Rarely is a
single sign or symptom diagnostic.
Metastasis to the bone marrow or
central nervous system may produce
manifestations of leukemia.
3. The manifestations are not just limited to
the abdomen, and NHL is not usually
seen in young children.
4. There is not just lower extremity involvement with NHL.
TEST-TAKING HINT: Review the difference
between Hodgkin disease and nonHodgkin lymphoma.
55. 1. The clinical staging system used in
Hodgkin disease is of little value in
lymphoma. Other systems have been
developed.
2. The use of aggressive combination
chemotherapy has a major impact on
the survival rates for children with a
diagnosis of lymphoma. Because there
is usually bone marrow involvement,
there is a need for central nervous
system prophylaxis.
3. Not all children receive a bone marrow
transplant.
4. Usually there is a good prognosis for
lymphoma with aggressive chemotherapy.
TEST-TAKING HINT: Be careful not to answer a question with a response that has
the word “all” in it, because rarely will
something always occur.
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CHAPTER 7 HEMATOLOGICAL
56. 1. Tumor involvement in the bone is usually
osteosarcoma.
2. Tumors that are located in the kidney are
most often a Wilms tumor.
3. Neuroblastoma tumors originate from
embryonic neural crest cells that normally give rise to the adrenal medulla
and the sympathetic nervous system.
The majority of the tumors arise from
the adrenal gland or from the
retroperitoneal sympathetic chain.
Therefore, the primary site is within
the abdomen.
4. In most tumors in children, there is liver
involvement when there is metastasis to
the liver.
TEST-TAKING HINT: Review the origin of
neuroblastoma to determine the tumor
sites.
57. 1. CMV infection is one common characteristic of human immunodeficiency virus
infections, but it is not the most common.
2. Encephalitis is not a specific opportunistic
infection noted in human immunodeficiency virus–infected children.
3. Meningitis is not a specific opportunistic
infection noted in human immunodeficiency virus–infected children.
4. Pneumocystis carinii pneumonia is the
most common opportunistic infection
that can occur in human immunodeficiency virus–infected children, and
such children are treated prophylactically for this.
TEST-TAKING HINT: Note the words “most
common” in the question.
58. 1. The CD4 cell count indicates how well
the immune system is working.
2. A Western blot test confirms the presence
of human immunodeficiency virus
antibodies.
OR IMMUNOLOGICAL
DISORDERS
3. An IgG level samples the immune system.
4. Detection of human immunodeficiency
virus in infants is confirmed by a p24
antigen assay, viral culture of human
immunodeficiency virus, or polymerase chain reaction.
TEST-TAKING HINT: Review the laboratory
tests for HIV-infected clients. The important word in the question is “infant.”
59. 1. Hepatitis B vaccine is administered
according to the immunization schedule.
2. The varicella vaccine is avoided in the
child who is human immunodeficiency
virus infected.
3. A Western blot test is not done and is
not necessary.
4. Immunizations against childhood
illnesses are recommended for children exposed to or infected with
human immunodeficiency virus.
Pneumococcal and influenza vaccines
are recommended.
TEST-TAKING HINT: Review the immunization schedule, keeping in mind that
human immunodeficiency virus–infected
children should not receive live viruses.
60. 1. The child can attend day care. The risk of
transmission remains the same at any age.
2. The child can attend day care without
any limitations but should not attend
with a fever.
3. There is no need to restrict the child’s
activity.
4. There is no law that requires notification
of the child’s condition.
TEST-TAKING HINT: Review the modes of
transmission of human immunodeficiency
virus infection in children. The day-care
facility should practice universal precautions when caring for all its children.
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Gastrointestinal
Disorders
8
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Anorectal malformation
Anterior fontanel
Appendectomy
Bile
Biliary atresia
Bowel obstruction
Celiac disease
Cholestyramine
Cleft lip
Cleft palate
Congenital aganglionic megacolon
Constipation
Dehydration
Electrolytes
Encopresis
Enterocolitis
Esophageal atresia
Esophagus
Fistula
Fluid maintenance
Fundus
Gastroenteritis
Gastroesophageal reflux
Gastrostomy tube
Gluten
Hepatitis
Hirschsprung disease
Imperforate anus
Intestinal villi
Intussusception
Jaundice
Jejunal biopsy
Kasai procedure
Malabsorption
Malaise
Necrotizing enterocolitis
Nissen fundoplication
Occult blood
Patient-controlled analgesia
Peristalsis
Peritonitis
Polyhydramnios
Prilosec (omeprazole)
Pyloric stenosis
Reglan (metoclopramide)
Rotavirus
Rovsing sign
Short bowel syndrome
Stimulant laxative
Stoma
Stool softener
Sudden infant death syndrome
Tracheoesophageal fistula
Umbilical hernia
Vomiting
Yankauer suction
Zofran (ondansetron)
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ABBREVIATIONS
Gastroesophageal reflux (GER)
Gastrostomy tube (GT)
Nasogastric tube (NGT)
Necrotizing enterocolitis (NEC)
Nothing by mouth (NPO)
Patient-controlled analgesia (PCA)
Short bowel syndrome (SBS)
Sudden infant death syndrome (SIDS)
Total parenteral nutrition (TPN)
QUESTIONS
1. The parent of a newborn asks, “Will my baby spit out the formula if it is too hot or
too cold?” Select the nurse’s best response.
1. “Babies have a tendency to reject hot fluids but not cold fluids, which could result
in abdominal discomfort.”
2. “Babies have a tendency to reject cold fluids but not hot fluids, which could result
in esophageal burns.”
3. “Your baby would most likely spit out formula that was too hot, but your baby
could swallow some of it, which could result in a burn.”
4. “Your baby is too young to be physically capable of spitting out fluids and will
automatically swallow anything.”
2. The mother of a newborn asks the nurse why the infant has to nurse so frequently.
Which is the best response?
1. Formula tends to be more calorically dense, and formula-fed babies require fewer
feedings than breastfed babies.
2. The newborn’s stomach capacity is small, and peristalsis is slow.
3. The newborn’s stomach capacity is small, and peristalsis is more rapid than in older
children.
4. Breastfed babies tend to take longer to complete a feeding than formula-fed babies.
3. A 4-month-old has had vomiting and diarrhea for 24 hours. The infant is fussy, and
the anterior fontanel is sunken. The nurse notes the infant does not produce tears
when crying. Which task will help confirm the diagnosis of dehydration?
1. Urinalysis obtained by bagged specimen.
2. Urinalysis obtained by sterile catheterization.
3. Analysis of serum electrolytes.
4. Analysis of cerebrospinal fluid.
4. A 4-month-old is brought to the emergency department with severe dehydration. The
heart rate is 198, and her blood pressure is 68/38. The infant’s anterior fontanel is
sunken. The nurse notes that the infant does not cry when the intravenous line is
inserted. The child’s parents state that she has not “held anything down” in 18 hours.
The nurse obtains a finger-stick blood sugar of 94. Which would the nurse expect to
do immediately?
1. Administer a bolus of normal saline.
2. Administer a bolus of D10W.
3. Administer a bolus of normal saline with 5% dextrose added to the solution.
4. Offer the child an oral rehydrating solution such as Pedialyte.
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CHAPTER 8 GASTROINTESTINAL DISORDERS
5. The nurse is caring for a 2-year-old child who was admitted to the pediatric unit for
moderate dehydration due to vomiting and diarrhea. The child is restless, with periods
of irritability. The child is afebrile with a heart rate of 148 and a blood pressure of
90/42. Baseline laboratory tests reveal the following: Na 152, Cl 119, and glucose 115.
The parents state that the child has not urinated in 12 hours. After establishing a
saline lock, the nurse reviews the physician’s orders. Which order should the nurse
question?
1. Administer a saline bolus of 10 mL/kg, which may be repeated if the child does not
urinate.
2. Recheck serum electrolytes in 12 hours.
3. After the saline bolus, begin maintenance fluids of D5 1/4 NS with 10 mEq KCl/L.
4. Give clear liquid diet as tolerated.
6. The parent of a 5-year-old states that the child has been having diarrhea for 24 hours,
vomited twice 2 hours ago, and now claims to be thirsty. The parent asks what to offer
the child because the child is refusing Pedialyte. Select the nurse’s most appropriate
response.
1. “You can offer clear diet soda such as Sprite and ginger ale.”
2. “Pedialyte is really the best thing for your child, who, if thirsty enough, will
eventually drink it.”
3. “Pedialyte is really the best thing for your child. Allow your child some choice in
the way to take it by offering small amounts in a spoon, medicine cup, or syringe.”
4. “It really does not matter what your child drinks as long as it is kept down. Try
offering small amounts of fluids in medicine cups.”
7. The nurse is caring for a 9-month-old with diarrhea secondary to rotavirus. The child
has not vomited and is mildly dehydrated. Which is likely to be included in the
discharge teaching?
1. Administer Imodium as needed.
2. Administer Kaopectate as needed.
3. Continue breastfeeding per routine.
4. The infant may return to day care 24 hours after antibiotics have been started.
8. Which child can be discharged without further evaluation?
1. A 2-year-old who has had 24 hours of watery diarrhea that has changed to bloody
diarrhea in the past 12 hours.
2. A 2-year-old who had a relapse of one diarrhea episode after restarting a normal
diet.
3. A 6-year-old who has been having vomiting and diarrhea for 2 days and has
decreased urine output.
4. A 10-year-old who has just returned from a Scout camping trip and has had several
episodes of diarrhea.
9. The nurse receives a call from the parent of a 10-month-old who has vomited three
times in the past 8 hours. The parent describes the baby as playful and wanting to
drink. The parent asks the nurse what to give the child. Select the nurse’s best
response.
1. “Replace the next feeding with regular water, and see if that is better tolerated.”
2. “Do not allow your baby to eat any solids; give half the normal formula feeding,
and see if that is better tolerated.”
3. “Do not let your baby eat or drink anything for 24 hours to give the stomach a
chance to rest.”
4. “Give your child 1/2 ounce of Pedialyte every 10 minutes. If vomiting continues,
wait an hour, and then repeat what you previously gave.”
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10. The parents of a 4-year-old ask the nurse how to manage their child’s constipation.
Select the nurse’s best response.
1. “Add 2 ounces of apple or pear juice to the child’s diet.”
2. “Be sure your child eats a lot of fresh fruit such as apples and bananas.”
3. “Encourage your child to drink more fluids.”
4. “Decrease bulky foods such as whole-grain breads and rice.”
11. A child is diagnosed with chronic constipation that has been unresponsive to dietary
and activity changes. Which pharmacological measure is most appropriate?
1. Natural supplements and herbs.
2. Stimulant laxative.
3. Osmotic agent.
4. Pharmacological measures are not used in pediatric constipation.
12. Which discharge instruction for a child diagnosed with encopresis should the nurse
question?
1. Limit the intake of milk.
2. Offer a diet high in protein.
3. Obtain a complete dietary log.
4. Follow up with a child psychologist.
13. The nurse is caring for an infant diagnosed with Hirschsprung disease. The mother
states she is pregnant with a boy and wants to know if her new baby will likely have
the disorder. Select the nurse’s best response.
1. “Genetics play a small role in Hirschsprung disease, so there is a chance the baby
will develop it as well.”
2. “There is no evidence to support a genetic link, so it is very unlikely the baby will
also have it.”
3. “It is rarely seen in boys, so it is not likely your new baby will have Hirschsprung
disease.”
4. “Hirschsprung disease is seen only in girls, so your new baby will not be at risk.”
14. The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What
does the nurse understand about this infant’s condition?
1. There is a lack of peristalsis in the large intestine and an accumulation of bowel
contents, leading to abdominal distention.
2. There is excessive peristalsis throughout the intestine, resulting in abdominal
distention.
3. There is a small-bowel obstruction leading to ribbon-like stools.
4. There is inflammation throughout the large intestine, leading to accumulation of
intestinal contents and abdominal distention.
15. The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung
disease. His parents call the nurse and show her his diaper containing a large amount
of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his
abdomen appears very distended. Which should be the nurse’s next action?
1. Reassure the parents that this is an expected finding and not uncommon.
2. Call a code for a potential cardiac arrest, and stay with the infant.
3. Immediately obtain all vital signs with a quick head-to-toe assessment.
4. Obtain a stool sample for occult blood.
16. The nurse is caring for an 8-week-old male who has just been diagnosed with
Hirschsprung disease. The parents ask what they should expect. Select the nurse’s
best response.
1. “It is really an easy disease to manage. Most children are placed on stool softeners
to help with constipation until it resolves.”
2. “A permanent stool diversion, called a colostomy, will be placed by the surgeon to
bypass the narrowed area.”
3. “Daily bowel irrigations will help your child maintain regular bowel habits.”
4. “Although your child will require surgery, there are different ways to manage the
disease, depending on how much bowel is involved.”
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17. Which should the nurse include in the plan of care to decrease symptoms of
gastroesophageal reflux (GER) in a 2-month-old? Select all that apply.
1. Place the infant in an infant seat immediately after feedings.
2. Place the infant in the prone position immediately after feeding to decrease the
risk of aspiration.
3. Encourage the parents not to worry because most infants outgrow GER within
the first year of life.
4. Encourage the parents to hold the infant in an upright position for 30 minutes
following a feeding.
5. Suggest that the parents burp the infant after every 1–2 ounces consumed.
18. The nurse knows that Nissen fundoplication involves which of the following?
1. The fundus of the stomach is wrapped around the inferior stomach, mimicking a
lower esophageal sphincter.
2. The fundus of the stomach is wrapped around the inferior esophagus, mimicking
a cardiac sphincter.
3. The fundus of the stomach is wrapped around the middle portion of the stomach,
decreasing the capacity of the stomach.
4. The fundus of the stomach is dilated, decreasing the likelihood of reflux.
19. The nurse is caring for a 4-month-old with gastroesophageal reflux (GER). The
infant is due to receive Zantac (rantadine). Based on the medication’s mechanism of
action, when should this medication be administered?
1. Immediately before a feeding.
2. 30 minutes after the feeding.
3. 30 minutes before the feeding.
4. At bedtime.
20. The nurse is administering Prilosec (omeprazole) to a 3-month-old with gastroesophageal reflux (GER). The child’s parents ask the nurse how the medication
works. Select the nurse’s best response.
1. “Prilosec is a proton pump inhibitor that is commonly used for reflux in infants.”
2. “Prilosec decreases stomach acid, so it will not be as irritating when your child
spits up.”
3. “Prilosec helps food move through the stomach quicker, so there will be less
chance for reflux.”
4. “Prilosec relaxes the pressure of the lower esophageal sphincter.”
21. A 10-year-old is being evaluated for possible appendicitis and complains of nausea
and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is
scheduled, and a blood count has been obtained. The child vomits, finds the pain
relieved, and calls the nurse. Which should be the nurse’s next action?
1. Cancel the ultrasound, and obtain an order for oral Zofran (ondansetron).
2. Cancel the ultrasound, and prepare to administer an intravenous bolus.
3. Prepare for the probable discharge of the patient.
4. Immediately notify the physician of the child’s status.
22. The parents of a child being evaluated for appendicitis tell the nurse the physician
said their child has a positive Rovsing sign. They ask the nurse what this means.
Select the nurse’s best response.
1. “Your child’s physician should answer that question.”
2. “A positive Rovsing sign means the child feels pain in the right side of the
abdomen when the left side is palpated.”
3. “A positive Rovsing sign means pain is felt when the physician removes the hand
from the abdomen.”
4. “A positive Rovsing sign means pain is felt in the right lower quadrant when the
child coughs.”
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23. Which is the best position for an 8-year-old who has just returned to the pediatric
unit after an appendectomy for a ruptured appendix?
1. Semi-Fowler.
2. Prone.
3. Right side-lying.
4. Left side-lying.
24. The nurse is to receive a 4-year-old from the recovery room after an appendectomy.
The parents have not seen the child since surgery and ask what to expect. Select the
nurse’s best response.
1. “Your child will be very sleepy, have an intravenous line in the hand, and have a
nasal tube to help drain the stomach. If your child needs pain medication, it will
be given intravenously.”
2. “Your child will be very sleepy, have an intravenous line in the hand, and have
white stockings to help prevent blood clots. If your child needs pain medication,
we will give it intravenously or provide a liquid to swallow.”
3. “Your child will be wide awake and will have an intravenous line in the hand. If
your child needs pain medication, we will give it intravenously or provide a liquid
to swallow.”
4. “Your child will be very sleepy and have an intravenous line in the hand. If your
child needs pain medication, we will give it intravenously.”
25. The nurse is caring for a 5-year-old who has just returned from having an appendectomy.
Which is the optimal way to manage pain?
1. Intravenous morphine as needed.
2. Liquid Tylenol (acetaminophen) with codeine as needed.
3. Morphine administered through a PCA pump.
4. Intramuscular morphine as needed.
26. The nurse is caring for a 3-year-old who had an appendectomy 2 days ago. The child
has a fever of 101.8°F (38.8°C) and breath sounds are slightly diminished in the right
lower lobe. Which action is most appropriate?
1. Teach the child how to use an incentive spirometer.
2. Encourage the child to blow bubbles.
3. Obtain an order for intravenous antibiotics.
4. Obtain an order for Tylenol (acetaminophen).
27. The nurse is providing discharge instructions to the parents of a child who had an
appendectomy for a ruptured appendix 5 days ago. The nurse knows that further
education is required when the parent states:
1. “We will wait a few days before allowing our child to return to school.”
2. “We will wait 2 weeks before allowing our child to return to sports.”
3. “We will call the pediatrician’s office if we notice any drainage around the
wound.”
4. “We will encourage our child to go for walks every day.”
28. Which manifestations should the nurse expect to find in a child in the early stages of
acute hepatitis?
1. Nausea, vomiting, and generalized malaise.
2. Nausea, vomiting, and pain in the left upper quadrant.
3. Generalized malaise and yellowing of the skin and sclera.
4. Yellowing of the skin and sclera without any other generalized complaints.
29. Which foods should be offered to a child with hepatitis?
1. A tuna sandwich on whole wheat bread and a cup of skim milk.
2. Clear liquids, such as broth, and Jell-O.
3. A hamburger, French fries, and a diet soda.
4. A peanut butter sandwich and a milkshake.
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30. Which would be an appropriate activity for the nurse to recommend to the parent of
a toddler just diagnosed with acute hepatitis?
1. Climbing in a “playscape.”
2. Kicking a ball.
3. Playing video games in bed.
4. Playing with puzzles in bed.
31. Which manifestation would the nurse expect to see in a 4-week-old infant with
biliary atresia?
1. Abdominal distention, enlarged liver, enlarged spleen, clay-colored stool, and
tea-colored urine.
2. Abdominal distention, multiple bruises, bloody stools, and hematuria.
3. Yellow sclera and skin tones, excessively oily skin, and prolonged bleeding times.
4. No manifestations until the disease has progressed to the advanced stage.
32. The nurse is caring for an infant with biliary atresia. The parents ask why the child is
receiving cholestyramine. Select the nurse’s best response.
1. To lower your child’s cholesterol.
2. To relieve your child’s itching.
3. To help your child gain weight.
4. To help feedings be absorbed in a more efficient manner.
33. Which is an accurate description of a Kasai procedure?
1. A palliative procedure in which the bile duct is attached to a loop of bowel to
assist with bile drainage.
2. A curative procedure in which a connection is made between the bile duct and a
loop of bowel to assist with bile drainage.
3. A curative procedure in which the bile duct is banded to prevent bile leakage.
4. A palliative procedure in which the bile duct is banded to prevent bile leakage.
34. The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when
their child’s lip and palate will most likely be repaired. Select the nurse’s best
response.
1. “The palate and the lip are usually repaired in the first few weeks of life so that
the baby can grow and gain weight.”
2. “The palate and the lip are usually not repaired until the baby is approximately
6 months old so that the mouth has had enough time to grow.”
3. “The lip is repaired in the first few months of life, but the palate is not usually
repaired until the child is 3 years old.”
4. “The lip is repaired in the first few weeks of life, but the palate is not usually
repaired until the child is 18 months old.”
35. The nurse is caring for a newborn with a cleft lip and palate. The mother states, “I
will not be able to breastfeed my baby.” Select the nurse’s best response.
1. “It sounds like you are feeling discouraged. Would you like to talk about it?”
2. “Sometimes breastfeeding is still an option for babies with a cleft lip and palate.
Would you like more information?”
3. “Although breastfeeding is not an option, you have the option of pumping your
milk and then feeding it to your baby with a special nipple.”
4. “We usually discourage breastfeeding babies with cleft lip and palate as it puts
them at an increased risk for aspiration.”
36. The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired.
Select the best position for the child in the immediate post-operative period.
1. Right side-lying.
2. Left side-lying.
3. Supine.
4. Prone.
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37. Which should be included in the plan of care for a 14-month-old whose cleft palate
was repaired 12 hours ago? Select all that apply.
1. Allow the infant to have familiar items of comfort such as a favorite stuffed animal
and a “sippy” cup.
2. Once liquids have been tolerated, encourage a bland diet such as soup, Jell-O, and
saltine crackers.
3. Administer pain medication on a regular schedule, as opposed to an as-needed
schedule.
4. Use a Yankauer suction catheter on the infant’s mouth to decrease the risk of
aspiration of oral secretions.
5. When discharged, remove elbow restraints.
38. The nurse is caring for a newborn with esophageal atresia. When reviewing the
mother’s history, which would the nurse expect to find?
1. Maternal polyhydramnios.
2. Pregnancy lasting more than 38 weeks.
3. Poor nutrition during pregnancy.
4. Alcohol consumption during pregnancy.
39. Which should be the nurse’s immediate action when a newborn begins to cough and
choke and becomes cyanotic while feeding?
1. Inform the physician of the situation.
2. Have the mother stop feeding the infant, and observe to see if the choking
episode resolves on its own.
3. Immediately determine the infant’s oxygen saturation, and have the mother stop
feeding the infant.
4. Take the infant from the mother, and administer blow-by oxygen while obtaining
the infant’s oxygen saturation.
40. The nurse is caring for a newborn who has just been diagnosed with tracheoesophageal fistula and is scheduled for surgery. Which should the nurse expect
to do in the pre-operative period?
1. Keep the child in a monitored crib, obtain frequent vital signs, and allow the
parents to visit but not hold their infant.
2. Administer intravenous fluids and antibiotics.
3. Place the infant on 100% oxygen via a non-rebreather mask.
4. Have the mother feed the infant slowly in a monitored area, stopping all feedings
4 to 6 hours before surgery.
41. The nurse is giving discharge instructions to the parent of a 1-month-old infant with
tracheoesophageal fistula and a gastrostomy tube (GT). The nurse knows the mother
understands the discharge teaching when she states:
1. “I will give my baby feedings through the GT but place liquid medications in the
corner of the mouth to be absorbed.”
2. “I will flush the GT with 2 ounces of water after each feeding to prevent the GT
from clogging.”
3. “I will clean the area around the GT with soap and water every day.”
4. “I will place petroleum jelly around the GT if any redness develops.”
42. An expectant mother asks the nurse if her new baby will have an umbilical hernia.
The nurse bases the response on the fact that it occurs:
1. More often in large infants.
2. In white infants more than in African American infants.
3. Twice as often in male infants.
4. More often in premature infants.
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43. The nurse is providing discharge teaching to the parents of an infant with an
umbilical hernia. Which should be included in the plan of care?
1. If the hernia has not resolved on its own by the age of 12 months, surgery is
generally recommended.
2. If the hernia appears to be more swollen or tender, seek medical care immediately.
3. To help the hernia resolve, place a pressure dressing over the area gently.
4. If the hernia is repaired surgically, there is a strong likelihood that it will return.
44. The nurse is caring for an infant with pyloric stenosis. The parent asks if any future
children will likely have pyloric stenosis. Select the nurse’s best response.
1. “You seem worried; would you like to discuss your concerns?”
2. “It is very rare for a family to have more than one child with pyloric stenosis.”
3. “Pyloric stenosis can run in families. It is more common among males.”
4. “Although there can be a genetic link, it is very unusual for girls to have pyloric
stenosis.”
45. The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis.
Which statement by the parent would be typical for a child with this diagnosis?
1. “The baby is a very fussy eater and just does not want to eat.”
2. “The baby tends to have a very forceful vomiting episode about 30 minutes after
most feedings.”
3. “The baby is always hungry after vomiting so I refeed.”
4. “The baby is happy in spite of getting really upset after spitting up.”
46. The nurse is caring for a 7-week-old scheduled for a pyloromyotomy in 24 hours.
Which would the nurse expect to find in the plan of care?
1. Keep infant NPO; begin intravenous fluids at maintenance.
2. Keep infant NPO; begin intravenous fluids at maintenance; place nasogastric tube
(NGT) to low wall suction.
3. Obtain serum electrolytes; keep infant NPO; do not attempt to pass NGT due to
obstruction.
4. Offer infant small frequent feedings; keep NPO 6 to 8 hours before surgery.
47. The nurse receives a call from the mother of a 6-month-old who describes her child as
alternately sleepy and fussy. She states that her infant vomited once this morning and
had two episodes of diarrhea. The last episode contained mucus and a small amount of
blood. She asks the nurse what she should do. Select the nurse’s best response.
1. “Your infant will need to have some tests in the emergency room to determine if
anything serious is going on.”
2. “Try feeding your infant in about 30 minutes; in the event of repeat vomiting, bring
the infant to the emergency room for some tests and intravenous rehydration.”
3. “Many infants display these symptoms when they develop an allergy to the formula they are receiving; try switching to a soy-based formula.”
4. “Do not worry about the blood and mucus in the stool; it is not unusual for infants to have blood in their stools because their intestines are more sensitive.”
48. The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The
infant has periods of irritability during which the knees are brought to chest and the
infant cries, alternating with periods of lethargy. Vital signs are stable and within
age-appropriate limits. The physician elects to give an enema. The parents ask the
purpose of the enema. Select the nurse’s most appropriate response.
1. “The enema will confirm the diagnosis. If the test result is positive, your child will
need to have surgery to correct the intussusception.”
2. “The enema will confirm the diagnosis. Although very unlikely, the enema may also
help fix the intussusception so that your child will not immediately need surgery.”
3. “The enema will help confirm the diagnosis and has a good chance of fixing the
intussusception.”
4. “The enema will help confirm the diagnosis and may temporarily fix the intussusception. If the bowel returns to normal, there is a strong likelihood that the
intussusception will recur.”
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49. The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F
(38.7°C), HR 181, BP 68/38. The reporting nurse states the infant’s abdomen is very
rigid. Which is the most appropriate action for the receiving nurse?
1. Prepare to accompany the infant to a computed tomography scan to confirm the
diagnosis.
2. Prepare to accompany the infant to the radiology department for a reducing enema.
3. Prepare to start a second intravenous line to administer fluids and antibiotics.
4. Prepare to get the infant ready for immediate surgical correction.
50. The nurse is providing discharge instructions to the parents of an infant who has
had surgery to open a low imperforate anus. The nurse knows that the discharge
instructions have been understood when the child’s parents say:
1. “We will use an oral thermometer because we cannot use a rectal one.”
2. “We will call the physician if the stools change in consistency.”
3. “Our infant will never be toilet-trained.”
4. “We understand that it is not unusual for our infant’s urine to contain stool.”
51. The nurse is caring for a neonate with an anorectal malformation. The nurse notes
that the infant has not passed any stool per rectum but the infant’s urine contains
meconium. The nurse can make which assumption?
1. The child likely has a low anorectal malformation.
2. The child likely has a high anorectal malformation.
3. The child will not need a colostomy.
4. This malformation will be corrected with a nonoperative rectal pull-through.
52. The nurse is caring for a newborn with an anorectal malformation and a colostomy.
The nurse knows that more education is needed when the infant’s parent states which
of the following?
1. “I will make sure the stoma is red.”
2. “There should not be any discharge or irritation around the outside of the stoma.”
3. “I will keep a bag attached to avoid the contents of the small intestine coming in
contact with the baby’s skin.”
4. “As my baby grows, a pattern will develop over time, and there should be predictable
bowel movements.”
53. The parent of a child being evaluated for celiac disease asks the nurse why it is
important to make dietary changes. Select the nurse’s best response.
1. “The body’s response to gluten causes damage to the mucosal cells in the intestine,
leading to absorption problems.”
2. “The body’s response to consumption of anything containing gluten is to create
special cells called villi, which leads to more diarrhea.”
3. “The body’s response to gluten causes the intestine to become more porous and
hang on to more of the fat-soluble vitamins, leading to vitamin toxicity.”
4. “The body’s response to gluten causes damage to the mucosal cells, leading to
malabsorption of water and hard, constipated stools.”
54. The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the
patient understands the diet instructions by ordering which of the following meals?
1. Eggs, bacon, rye toast, and lactose-free milk.
2. Pancakes, orange juice, and sausage links.
3. Oat cereal, breakfast pastry, and nonfat skim milk.
4. Cheese, banana slices, rice cakes, and whole milk.
55. Which would the nurse expect to be included in the diagnostic workup of a child
with suspected celiac disease?
1. Obtain complete blood count and serum electrolytes.
2. Obtain complete blood count and stool sample; keep child NPO.
3. Obtain stool sample and prepare child for jejunal biopsy.
4. Obtain complete blood count and serum electrolytes; monitor child’s response to
gluten-containing diet.
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56. Which manifestation suggests that an infant is developing necrotizing enterocolitis
(NEC)?
1. Absorption of bolus orogastric feedings at a faster rate than previous feedings.
2. Bloody diarrhea.
3. Increased bowel sounds.
4. Appears hungry right before a scheduled feeding.
57. The nurse is caring for a 1-month-old term infant who experienced an anoxic episode
at birth. The health-care team suspects that the infant is developing necrotizing enterocolitis (NEC). Which would the nurse expect to be included in the plan of care?
1. Immediately remove the feeding nasogastric tube (NGT) from the infant.
2. Obtain vital signs every 4 hours.
3. Prepare to administer antibiotics intravenously.
4. Change feedings to half-strength, administer slowly via a feeding pump.
58. More education about necrotizing enterocolitis (NEC) is needed in a nursing
in-service when one of the participants states:
1. “Encouraging the mother to pump her milk for the feedings helps prevent NEC.”
2. “Some sources state that the occurrence of NEC has increased because so many
preterm infants are surviving.”
3. “When signs of sepsis appear, the infant will likely deteriorate quickly.”
4. “NEC occurs only in preemies and low-birth-weight infants.”
59. The nurse is caring for an infant who has been diagnosed with short bowel syndrome
(SBS). The parent asks how the disease will affect the child. Select the nurse’s best
response.
1. “Because your child has a shorter intestine than most, your child will likely
experience constipation and will need to be placed on a bowel regimen.”
2. “Because your child has a shorter intestine than most, he will not be able to absorb
all the nutrients and vitamins in food and will need to get nutrients in other ways.”
3. “Unfortunately, most children with this diagnosis do not do very well.”
4. “The prognosis and course of the disease have changed because hyperalimentation
is available.”
60. The nurse is caring for a 3-month-old infant who has short bowel syndrome (SBS)
and has been receiving total parenteral nutrition (TPN). The parents ask if their
child will ever be able to eat. Select the nurse’s best response.
1. “Children with SBS are never able to eat and must receive all of their nutrition in
intravenous form.”
2. “You will have to start feeding your child because children cannot be on TPN
longer than 6 months.”
3. “We will start feeding your child soon so that the bowel continues to receive
stimulation.”
4. “Your child will start receiving tube feedings soon but will never be able to eat by
mouth.”
61. Which child may need extra fluids to prevent dehydration? Select all that apply.
1. 7-day-old receiving phototherapy.
2. 6-month-old with newly diagnosed pyloric stenosis.
3. 2-year-old with pneumonia.
4. 2-year-old with full-thickness burns to the chest, back, and abdomen.
5. 13-year-old who has just started her menses.
62. The nurse is interviewing the parents of a 6-year-old who has been experiencing
constipation. Which could be a causative factor? Select all that apply.
1. Hypothyroidism.
2. Muscular dystrophy.
3. Myelomeningocele.
4. Drinks a lot of milk.
5. Active in sports.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Swallowing is a reflex in neonates; infants
younger than 6 weeks cannot voluntarily
control swallowing.
2. Swallowing is a reflex in neonates; infants
younger than 6 weeks cannot voluntarily
control swallowing.
3. The infant is not capable of selectively
rejecting fluid because swallowing is a reflex
until 6 weeks.
4. Swallowing is a reflex in infants younger
than 6 weeks.
TEST-TAKING HINT: Swallowing is a reflex
that is present until the age of 6 weeks.
The test taker should eliminate answers 1,
2, and 3 as they suggest that the infant is
capable of selectively rejecting fluids.
2. 1. The caloric content of breast milk and
formula tends to be similar.
2. Peristalsis in infants is greater than in older
children.
3. The small-stomach capacity and rapid
movement of fluid through the digestive
system account for the need for small
frequent feedings.
4. Breastfed babies and formula-fed babies
do not necessarily have a difference in
feeding time.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 4 because they
both form generalizations that are not
supported by current literature.
3. 1. The information obtained from a urinalysis
of an infant is not as helpful as serum electrolytes. The infant has limited ability to
concentrate urine, so the specific gravity is
not usually affected.
2. The information obtained from a urinalysis of an infant is not as helpful as serum
electrolytes. The infant has limited ability
to concentrate urine, so the specific
gravity is not usually affected. A urinalysis
does not need to be obtained by
catheterization.
3. The analysis of serum electrolytes
offers the most information and assists
with the diagnosis of dehydration.
146
4. Although critical in diagnosing meningitis, a
lumber puncture and analysis of cerebrospinal
fluid are not done to confirm dehydration.
TEST-TAKING HINT: Infants have limited
ability to concentrate urine, so answers
1 and 2 can be eliminated immediately.
4. 1. Dehydration is corrected with the
administration of an isotonic solution,
such as normal saline or lactated Ringer
solution.
2. Solutions containing dextrose should never
be administered in bolus form because they
may result in cerebral edema.
3. Solutions containing dextrose should never
be administered in bolus form because they
may result in cerebral edema.
4. Severe dehydration is not usually corrected
with oral solutions; children with altered
levels of consciousness should be kept NPO.
TEST-TAKING HINT: The test taker should
immediately eliminate answers 2 and 3
as they both suggest administering glucose in bolus form, which is always
contraindicated in pediatric patients.
Answer 4 should be eliminated as the
infant is severely dehydrated and not
responding to painful stimulation,
which is suggested by the lack of a cry
on intravenous insertion.
5. 1. Fluid boluses of normal saline are administered according to the child’s body weight.
It is not unusual to have to repeat the bolus
multiple times in order to see an improvement in the child’s condition.
2. It is important to monitor serum electrolytes frequently in the dehydrated child.
3. Potassium is contraindicated because the
child has not yet urinated. Potassium is
not added to the maintenance fluid until
kidney function has been verified.
4. The child with dehydration secondary to
vomiting and diarrhea is placed on a clear
liquid diet.
TEST-TAKING HINT: Be aware of the usual
ways in which dehydration is treated.
Answer 3 should be selected because the
description states that the child has not
urinated.
6. 1. When Pedialyte is not tolerated, it is
usually recommended that clear sodas and
juices be diluted. Diet beverages are not
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CHAPTER 8 GASTROINTESTINAL DISORDERS
recommended because the sugar is needed
to help the sodium be reabsorbed.
2. Pedialyte is the best choice. If the child is
not encouraged to drink Pedialyte, the child
may become severely dehydrated. Other
ways to encourage oral rehydration need
to be considered.
3. Pedialyte is the first choice, as recommended by the American Academy of
Pediatrics. Offering the child appropriate choices may allow the child to feel
empowered and less likely to refuse the
Pedialyte. Small, frequent amounts are
usually better tolerated.
4. Offering small amounts of liquids is important. The type of beverage does matter
because many fluids may increase vomiting
and diarrhea.
TEST-TAKING HINT: The test taker should
eliminate answer 2 because it offers an
ultimatum to a child. The child is likely
to refuse the Pedialyte, worsening the state
of dehydration.
7. 1. Imodium slows intestinal motility and
allows overgrowth of organisms and should
therefore be avoided.
2. Kaopectate slows intestinal motility and
allows overgrowth of organisms and should
therefore be avoided.
3. Breastfeeding is usually well tolerated
and helps prevent death of intestinal villi
and malabsorption.
4. Antibiotics are not effective in viruses.
Children should not return to day care
while they are still having diarrhea.
TEST-TAKING HINT: The test taker can
eliminate answer 4 as antibiotics are not
effective with viruses such as rotavirus.
Answers 1 and 2 can be eliminated as
antidiarrheal agents are not recommended
in the pediatric population.
8. 1. Diarrhea containing blood needs further
evaluation to determine the source of the
blood and the child’s blood counts and
electrolyte balance.
2. It is common for children to have a
relapse of diarrhea after resuming a
regular diet.
3. Children who have had vomiting and
diarrhea for more than 2 days require evaluation to determine if IV rehydration and
hospital admission are necessary.
4. Diarrhea following a camping trip needs
further evaluation because it may be due to
bacteria or parasites.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 3 because they
describe children who may have altered
electrolytes and blood counts due to
prolonged diarrhea.
9. 1. Free water should not be given as it does
not contain any electrolytes and can lead
to critical electrolyte imbalances.
2. Formula should be avoided, and clear liquids such as Pedialyte should be offered.
3. Twenty-four hours is too long for the
infant to remain NPO. The infant needs
to drink a rehydration solution such
as Pedialyte in order to avoid severe
dehydration.
4. Offering small amounts of clear liquids
is usually well tolerated. If the child
vomits, make NPO to allow the stomach to rest and then restart fluids. The
child in this scenario is described as
playful and therefore does not appear
to be at risk for dehydration.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 3 because they
could cause harm to the infant.
10. 1. Two ounces of apple juice is most likely not
a sufficient quantity to alter a 4-year-old
child’s bowel movements.
2. Although fresh fruits help decrease
constipation, bananas tend to increase
constipation.
3. Increasing fluid consumption helps to
decrease the hardness of the stool.
4. Whole-grain bread is high in fiber and
helps decrease constipation.
TEST-TAKING HINT: Answer 1 decreases
constipation in the infant but not in the
preschooler.
11. 1. Natural supplements and herbs are not
recommended because the safety and
efficacy are not standardized.
2. A stimulant laxative is not the drug
of choice because it may increase
abdominal discomfort and may lead to
dependency.
3. A stool softener is the drug of choice
because it will lead to easier evacuation.
4. Although diet and activity modification
are tried first, medications are sometimes
needed.
TEST-TAKING HINT: The test taker should
eliminate answer 4 as it implies that medications are never given to the constipated
child. In health care, there are very few
cases of “never” and “always.”
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12. 1. Dairy products are limited as they can
lead to constipation.
2. A diet high in protein will cause more
constipation.
3. A complete dietary log should be kept
to help correlate the foods that lead to
constipation.
4. The child and family are encouraged
to seek counseling, as there is often a
psychological component to encopresis.
TEST-TAKING HINT: Recall the developmental needs of children and successful
approaches to meet their needs.
13. 1. There is a genetic component to
Hirschsprung disease, so any future
siblings are also at risk.
2. There is a genetic component to
Hirschsprung disease.
3. Hirschsprung disease is seen more
commonly in males than females.
4. Hirschsprung disease is seen in both
males and females but is more common
in males.
TEST-TAKING HINT: The test taker can
eliminate answers 3 and 4 as they are
similar and therefore would not likely be
the correct answer.
14. 1. In Hirschsprung disease, a portion of
the large intestine has an area lacking
in ganglion cells. This results in a lack
of peristalsis as well as an accumulation of bowel contents and abdominal
distention.
2. There is a lack of peristalsis at the
aganglionic section of the bowel.
3. Hirschsprung disease does not include a
small-bowel obstruction.
4. Hirschsprung disease does not present
with inflammation throughout the large
intestine.
TEST-TAKING HINT: The test taker should
be familiar with the pathophysiology of
Hirschsprung disease in order to select
answer 1.
15. 1. All cases of bloody diarrhea need to be
evaluated because this may be a sign of
enterocolitis, which is a potentially fatal
complication of Hirschsprung disease.
2. Although this is a potentially critical complication, calling a code is not necessary at
this time as the infant is irritable and not
unconscious.
3. All vital signs need to be evaluated
because the child with enterocolitis
can quickly progress to a state of
shock. A quick head-to-toe assessment
will allow the nurse to evaluate the
child’s circulatory system.
4. It is not a priority to test the stool for
occult blood, as there is obvious blood
in the sample.
TEST-TAKING HINT: The test taker should
select answer 3 because there is not
enough information to determine the
status of the child. Obtaining vital signs
will help the nurse to assess the situation.
16. 1. The constipation will not resolve with
stool softeners. The affected bowel needs
to be removed.
2. Most colostomies are not permanent.
The large intestine is usually reattached,
and the colostomy is taken down.
3. The child with Hirschsprung disease
requires surgery to remove the aganglionic portion of the large intestine.
4. The aganglionic portion needs to be
removed. Although most children
have a temporary colostomy placed,
many infants are able to bypass the
colostomy and have the bowel
immediately reattached.
TEST-TAKING HINT: The test taker should
be led to answer 4 as it is the least restrictive of all answers and is the only one that
states that the child will require surgery.
Children with Hirschsprung disease are
managed surgically.
17. 4, 5.
1. Placing the infant in an infant seat increases
intra-abdominal pressure, placing the infant
at increased risk for GER.
2. The prone position is not recommended
as it may lead to sudden infant death
syndrome (SIDS).
3. Although most infants outgrow GER,
providing the parents with this education
will not help decrease the symptoms.
4. Keeping the infant in an upright position is the best way to decrease the
symptoms of GER. The infant can
also be placed in the supine position
with the head of the crib elevated. A
harness can be used to keep the child
from sliding down.
5. Burping the infant frequently may help
decrease spitting up by expelling air
from the stomach more often.
TEST-TAKING HINT: The test taker may be
led to answer 3. However, the question is
looking for ways to decrease reflux.
Although decreasing parental anxiety may
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help decrease reflux, the better answers
are 4 and 5 as they are more likely to be
part of an effective management plan.
18. 1. The fundus is wrapped around the inferior esophagus, not the inferior stomach.
2. The Nissen fundoplication involves
wrapping the fundus of the stomach
around the inferior esophagus, creating a lower esophageal sphincter or
cardiac sphincter.
3. The fundus is not wrapped around the
middle portion of the stomach. There is no
benefit to decreasing the stomach’s capacity.
4. The fundus of the stomach is not dilated.
TEST-TAKING HINT: The test taker needs to
be familiar with surgical options for GER
disease.
19. 1. If Zantac is administered immediately
before a feeding, the medication will not
have enough time to take effect.
2. This medication should be administered
prior to a feeding to be effective.
3. Zantac decreases gastric acid secretion
and should be administered 30 minutes
before a feeding.
4. This medication should be administered
prior to a feeding to be effective.
TEST-TAKING HINT: The test taker needs to
be familiar with the administration of
Zantac.
20. 1. Although this is an accurate description of
the mechanism of action, it does not tell
the parents how the medication functions.
2. This accurate description gives the
parents information that is clear and
concise.
3. Prilosec does not increase the rate of
gastric emptying.
4. Prilosec does not relax the pressure of the
lower esophageal sphincter.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 4 because they do
not communicate information in a manner
that will be clear to many parents.
21. 1. The ultrasound should not be canceled
but obtained emergently because the child
probably has a perforated appendix. The
child should be NPO because surgery is
imminent.
2. The ultrasound should not be canceled
but obtained emergently because the child
probably has a perforated appendix.
3. The child will not be discharged due to
most likely having a perforated appendix.
4. The physician should be notified
immediately, as a sudden change
or loss of pain often indicates a
perforated appendix.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 2 because there is
no reason to cancel the ultrasound. The
physician should always be notified of any
changes in a patient’s condition.
22. 1. This response is not helpful and dismisses
the parent’s concern.
2. A positive Rovsing sign occurs when
the left lower quadrant is palpated and
pain is felt in the right lower quadrant.
3. Pain that is felt when the hand is removed
during palpation is called rebound
tenderness.
4. Pain that is felt when the child coughs is
called a positive cough sign.
TEST-TAKING HINT: The test taker should
immediately eliminate answer 1 because it
is not therapeutic and is dismissive.
23. 1. The semi-Fowler position does not
provide the most comfort to the
post-operative appendectomy child.
2. The prone position does not allow the
nurse to visualize the incision easily and
would probably be uncomfortable for
the child.
3. The right side-lying position promotes
comfort and allows the peritoneal
cavity to drain.
4. The left side-lying position may not
provide as much comfort and will not
allow the peritoneal cavity to drain as
freely as the right side-lying position.
TEST-TAKING HINT: The test taker should be
led to answer 3 because lying on the same
side as the abdominal incision is usually the
most comfortable for the child.
24. 1. An NGT is not needed when an appendix
has not ruptured.
2. Antiembolic stockings are not used in
children this young, who will likely be
moving the lower extremities and
ambulating.
3. The child in the immediate post-operative
period is usually not wide awake.
4. In the immediate post-operative
period, the child is usually sleepy but
can be roused. The child usually has
an intravenous line for hydration and
pain medication.
TEST-TAKING HINT: The test taker should
eliminate answer 1 because NGTs are not
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used unless the appendix has ruptured.
Answer 2 can also be eliminated because a
4-year-old who is post appendectomy is
not at risk for blood clots.
25. 1. Intravenous morphine given as needed
may cause the child to have periods of pain
when the medication has worn off. The
child may also be hesitant to ask for pain
medication, fearing an invasive procedure.
2. Liquid Tylenol with codeine may not
offer sufficient pain control in the
immediate post-operative period.
3. Morphine administered through a
PCA pump offers the child control
over managing pain. The PCA pump
also has the benefit of offering a basal
rate as well as an as-needed rate for
optimal pain management.
4. The intramuscular route should be
avoided if less invasive routes are available. A
5-year-old fears invasive procedures and may
deny pain to avoid receiving an injection.
TEST-TAKING HINT: The test taker recalls
that PCA pumps are very effective, even
in young children.
26. 1. Many 3-year-olds have difficulty understanding how to use an incentive spirometer.
2. Blowing bubbles is a developmentally
appropriate way to help the preschooler
take deep breaths and cough.
3. In the early post-operative period, a fever
is likely a respiratory issue and not a result
of infection of the incision.
4. Although acetaminophen may be administered, encouraging the child to breathe
deeply and cough will help prevent the
fever from returning.
TEST-TAKING HINT: The test taker should
be aware that a fever in the first few days
after surgery is generally due to pulmonary complications, so that answer
3 can be eliminated. Remembering the
developmental needs of the child, the
test taker should select answer 2.
27. 1. The child should wait a few days before
returning to school to avoid being easily
fatigued.
2. The child should wait 6 weeks before
returning to any strenuous activity.
3. Any signs of infection should be reported
to the primary care provider.
4. The child should be encouraged to walk
every day because it will help the bowels
return to normal and help the child
regain stamina.
TEST-TAKING HINT: The test taker should
note that the question is asking which of
the answers indicate that more education
is needed. Answer 2 should be selected
because 2 weeks is too early to return to
strenuous contact sports.
28. 1. The early stage of acute hepatitis is
referred to as the anicteric phase,
during which the child usually complains of nausea, vomiting, and
generalized malaise.
2. A tender enlarged liver is noted in the
right upper quadrant.
3. The child does not appear jaundiced until
the icteric phase.
4. The child does not appear jaundiced until
the icteric phase. The child usually does
not feel well during the early stages of
acute hepatitis.
TEST-TAKING HINT: The test taker needs to
be familiar with the manifestations of
acute hepatitis. Knowing that the early
stage is referred to as the anicteric phase,
answers 3 and 4 can be eliminated.
29. 1. A diet that is high in protein and
carbohydrates helps maintain caloric
intake and protein stores while
preventing muscle wasting. A low-fat
diet prevents abdominal distention.
2. The child should be encouraged to
consume a diet higher in protein.
3. The child should be encouraged to
consume a low-fat diet.
4. The child should be encouraged to
consume a low-fat diet.
TEST-TAKING HINT: The child with hepatitis is usually placed on a diet that is high
in both protein and carbohydrates but
low in fat.
30. 1. The child with acute hepatitis usually
does not feel well, and activities should be
limited to quiet, restful ones.
2. The child with acute hepatitis usually
does not feel well, and activities should be
limited to quiet, restful ones.
3. Video games are not developmentally
appropriate for a 3-year-old.
4. Playing with puzzles is a developmentally appropriate activity for a 3-year-old
on bedrest.
TEST-TAKING HINT: The test taker should
incorporate developmentally appropriate
activities for the child in the early stages
of acute hepatitis. Answers 1 and 2 can be
eliminated as they are not activities that
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can be done while resting. Answer 4
should be selected because it is a better
activity for a 3-year-old.
31. 1. The infant with biliary atresia usually
has an enlarged liver and spleen. The
stools appear clay-colored due to the
absence of bile pigments. The urine is
tea-colored due to the excretion of
bile salts.
2. The urine typically contains bile salts, not
blood. There is usually no blood noted in
the stool.
3. The skin is usually dry and itchy, not oily.
4. Manifestations of biliary atresia usually
appear by 3 weeks of life.
TEST-TAKING HINT: The test taker needs
to be familiar with the manifestations of
biliary atresia and should be led to select
answer 1.
32. 1. Although cholestyramine is used to lower
cholesterol, its primary purpose in the child
with biliary atresia is to relieve pruritus.
2. The primary reason cholestyramine is
administered to the child with biliary
atresia is to relieve pruritus.
3. Cholestyramine is not administered to
help the child gain weight.
4. Cholestyramine does not assist with the
absorption of feedings.
TEST-TAKING HINT: The test taker needs to
consider the manifestations of the disease
process when considering why medications are administered. The liver is unable
to eliminate bile, which leads to intense
pruritus.
33. 1. The Kasai procedure is a palliative
procedure in which the bile duct is
attached to a loop of bowel to assist
with bile drainage.
2. The procedure is palliative, not curative
because most children require a liver
transplant after a few years.
3. The Kasai procedure does not band the
bile duct.
4. The Kasai procedure does not band the
bile duct.
TEST-TAKING HINT: The test taker can
eliminate answers 2 and 3, as the majority
of cases of biliary atresia require a liver
transplant. The Kasai procedure is performed to give the child a few years to
grow before requiring a transplant.
34. 1. The palate is not repaired until the child is
approximately 18 months old to allow for
facial growth. Waiting beyond 18 months
may interfere with speech.
2. The lip is usually repaired in the first few
weeks of life, and the palate is usually
repaired at approximately 18 months.
3. The palate is repaired earlier than 3 years so
that speech development is not impaired.
4. The lip is repaired in the first few
weeks of life, but the palate is not
usually repaired until the child is
18 months old.
TEST-TAKING HINT: The test taker should
consider the palate’s involvement in the
development of speech and therefore
eliminate answer 3. The palate is usually
given at least a year to grow sufficiently.
35. 1. Encouraging parents to express their
feelings is important, but it is more
appropriate to give the parents
information on breastfeeding.
2. Some mothers are able to breastfeed
their infants who have a cleft lip and
palate. The breast can help fill in the
cleft and help the infant create suction.
3. Breastfeeding is sometimes an option.
4. Breastfeeding does not increase the risk of
aspiration among infants with a cleft lip
and palate.
TEST-TAKING HINT: The test taker should
be led to select answer 2 because the
breast can sometimes act to fill in the cleft.
36. 1. The infant may rub the face on the
bedding if positioned on the side.
2. The infant may rub the face on the
bedding if positioned on the side.
3. The supine position is preferred
because there is decreased risk of the
infant rubbing the suture line.
4. The infant may rub the face on the
bedding if positioned on the abdomen.
TEST-TAKING HINT: The test taker should
be led to answer 3 because it is the only
option in which the suture line is not at
increased risk for injury.
37. 1, 3.
1. The child should not be allowed to use
anything that creates suction in the
mouth, such as pacifiers or straws.
“Sippy” cups are acceptable.
2. The child should not have anything hard
in the mouth, such as crackers, cookies, or
a spoon.
3. Pain medication should be administered regularly to avoid crying, which
places stress on the suture line.
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4. A Yankauer suction should not be used in
the mouth because it creates suction and is
a hard instrument that could irritate the
suture line. The child should be positioned
to allow secretions to drain out of the
child’s mouth. Suction should be used only
in the event of an emergency.
5. Elbow restraints are used until the repaired
palate has healed. When at home, the parents need to monitor the child closely if
restraints are removed to move the arms or
for bathing.
TEST-TAKING HINT: The child who has had
a cleft palate repair should have nothing
in the mouth that could irritate the suture
line. Answers 2 and 4 can be eliminated.
38. 1. Maternal polyhydramnios is present
because the infant cannot swallow and
absorb the amniotic fluid in utero.
2. Many mothers of infants with esophageal
atresia deliver early due to the pressure of
the unabsorbed amniotic fluid.
3. Although good nutrition is essential in
every pregnancy, there is not a direct
relationship between diet and esophageal
atresia.
4. Although alcohol should not be consumed
in any pregnancy, there is not a direct link
between diet and esophageal atresia.
TEST-TAKING HINT: The test taker should
select answer 1 because esophageal atresia
prevents the fetus from ingesting amniotic fluid, leading to increased amniotic
fluid in utero.
39. 1. The infant’s feeding should be stopped
immediately and oxygen administered.
The nurse should call for help but should
not leave the infant while in distress.
2. The mother should stop feeding the
infant, but oxygen should be applied
while the infant is cyanotic. The infant
should be placed on a monitor, and vital
signs should be obtained.
3. Although obtaining oxygen saturations is
extremely important, the infant is visually
cyanotic, so the nurse should administer
oxygen as a priority.
4. The infant should be taken from the
mother and placed in the crib where
the nurse can assess the baby. Oxygen
should be administered immediately,
and vital signs should be obtained.
TEST-TAKING HINT: The test taker should
be led to answer 4 because the baby is
cyanotic and needs oxygen.
40. 1. The infant should be monitored, and vital
signs should be obtained frequently, but
the parents should be encouraged to hold
their baby.
2. Intravenous fluids are administered to
prevent dehydration because the infant
is NPO. Intravenous antibiotics are
administered to prevent pneumonia
because aspiration of secretions is
likely.
3. The infant should receive only the
amount of oxygen needed to keep
saturations above 94%.
4. As soon as the diagnosis is made, the
infant is made NPO because the risk for
aspiration is extremely high.
TEST-TAKING HINT: Infants with tracheoesophageal fistula are at great risk for
aspiration and subsequent pneumonia.
With this knowledge, the test taker should
eliminate answer 4 and select answer 2.
41. 1. Medications can be placed in the GT also.
2. Two ounces of water is too much water
for an infant and could cause electrolyte
imbalances. The tube can be flushed with
3 to 5 mL of water to prevent clogging.
3. The area around the GT should be
cleaned with soap and water to prevent
an infection.
4. If redness develops, the parents should
call the physician because an infection
could be present.
TEST-TAKING HINT: The test taker should
immediately eliminate answer 1 because
medications and feedings can be placed in
the GT. The test taker should recall that
2 ounces of water after each feeding is a
large amount (recalling that infants are
typically fed at least every 4 hours).
42. 1. Umbilical hernias occur more often in
low-birth-weight infants.
2. Umbilical hernias occur more often in
African American infants than in white
infants.
3. Umbilical hernias affect males and
females equally.
4. Umbilical hernias occur more often in
premature infants.
TEST-TAKING HINT: The test taker needs to
be familiar with the occurrence of umbilical
hernias.
43. 1. Most umbilical hernias resolve spontaneously by age 2 to 3 years. Surgery is not
usually recommended until the age of 3
because the hernia may resolve before that.
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2. If the hernia appears larger, swollen,
or tender, the intestine may be
trapped, which is a surgical emergency.
3. A pressure dressing should never be
placed over the hernia because it can
cause irritation and does not help the
hernia resolve.
4. If the hernia is corrected surgically, the
recurrence rate is low.
TEST-TAKING HINT: The test taker should
be led to select answer 2 because a
change in the hernia indicates an incarcerated hernia, which is an emergency.
44. 1. This approach sounds like the nurse is
avoiding the mother’s question. It would
be better to offer the information and
then ask about her concerns.
2. It is not at all uncommon for a family to
have multiple children with pyloric stenosis.
3. Pyloric stenosis can run in families,
and it is more common in males.
4. Although pyloric stenosis occurs more
often in males, it can occur in females,
especially in siblings of a child with
pyloric stenosis.
TEST-TAKING HINT: The test taker needs to
be familiar with pyloric stenosis.
45. 1. Infants with pyloric stenosis tend to be
perpetually hungry because most of their
feedings do not get absorbed.
2. Infants with pyloric stenosis vomit immediately after a feeding, especially as the
pylorus becomes more hypertrophied.
3. Infants with pyloric stenosis are always
hungry and often appear malnourished.
4. Most infants with pyloric stenosis are
irritable because they are hungry. Parents
do not usually describe the vomiting
episodes as “spitting up” because infants
tend to have projectile vomiting.
TEST-TAKING HINT: Recall the dynamics of
pyloric stenosis. Because feedings are not
absorbed, the infant is irritable and hungry. The test taker can eliminate answers
1 and 4 and select answer 3.
46. 1. In addition to giving fluids intravenously
and keeping the infant NPO, an NGT is
placed to decompress the stomach.
2. In addition to giving fluids intravenously and keeping the infant NPO,
an NGT is placed to decompress the
stomach.
3. The pylorus is distal to the stomach, so an
NGT is placed above the obstruction.
4. The infant is made NPO as soon as diagnosis is confirmed. Allowing the infant
to feed perpetuates the vomiting and
continued hypertrophy of the pylorus.
TEST-TAKING HINT: The test taker should
consider the pathophysiology of pyloric
stenosis and eliminate answers 1, 3, and 4.
47. 1. The infant is displaying signs of intussusception. This is an emergency that
needs to be evaluated to prevent ischemia and perforation.
2. The mother should be told not to give
the infant anything by mouth and bring
the infant immediately to the emergency
room.
3. Although similar symptoms may be seen
among infants with allergies, a more
serious illness must first be ruled out. It is
uncommon to see lethargy as a response
to an allergy.
4. All bloody stools should be evaluated.
TEST-TAKING HINT: The child is described
as lethargic and is having diarrhea and
vomiting. This child needs to be seen to
rule out an intussusception. At the very
least, the mother should be told to bring
the child to the emergency room because
the described signs could also be seen in
severe dehydration. The test taker should
be led to select answer 1.
48. 1. The enema is used for confirmation of
diagnosis and reduction. In most cases of
intussusception in young children, an
enema is successful in reducing the
intussusception.
2. In most cases of intussusception in young
children, an enema is successful in reducing
the intussusception.
3. In most cases of intussusception in
young children, an enema is successful
in reducing the intussusception.
4. There is not a high likelihood that the
intussusception will recur.
TEST-TAKING HINT: The test taker needs to
be aware that intussusceptions in young
children respond well to reduction by
enema.
49. 1. The child has already been diagnosed and
appears to have developed peritonitis,
which is a surgical emergency.
2. Although reducing enemas have a high
success rate among infants with intussusception, they are contraindicated in the
presence of peritonitis.
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3. Although a second intravenous line may
be needed, the nurse’s first priority is
getting the child to the operating room.
4. Intussusception with peritonitis is a
surgical emergency, so preparing the
infant for surgery is the nurse’s top
priority.
TEST-TAKING HINT: The child has already
been diagnosed and is displaying signs of
shock and peritonitis. The nurse must
act quickly and get the child the surgical
attention needed to avoid disastrous
consequences.
50. 1. Although a rectal thermometer should
never be used in a child with an anorectal
malformation, an oral thermometer
should not be used in an infant or young
child.
2. A change in stool consistency is
important to report because it could
indicate stenosis of the rectum.
3. The child with a low anorectal malformation should be capable of achieving bowel
continence.
4. Any stool in the urine should be reported
because it indicates a fistula is present.
TEST-TAKING HINT: The test taker should
eliminate answer 3 as it contains the word
“never.” There are very few circumstances
in health care in which “never” is the case.
51. 1. The child who has stool in the urine has a
fistula connecting the rectum to the urinary tract, and the anorectal malformation
cannot be low.
2. The presence of stool in the urine
indicates that the anorectal malformation is high.
3. This child probably needs a colostomy.
4. This malformation requires surgical
correction.
TEST-TAKING HINT: The test taker needs to
consider that stool is present in the urine,
indicating a fistula is present and a more
complex anorectal malformation exists, so
answers 1 and 4 can be eliminated.
52. 1. The stoma should be red in color,
indicating good perfusion.
2. Discharge or irritation around the stoma
could indicate the presence of an infection.
3. The colostomy contains stool from the
large intestine; an ileostomy contains
the very irritating stool from the small
intestine.
4. Babies usually develop a pattern to their
bowel habits as they grow.
TEST-TAKING HINT: Although it is important to keep a bag attached to the
colostomy, the contents are not the
irritating effluent of an ileostomy.
53. 1. The inability to digest protein leads to
an accumulation of an amino acid that
is toxic to the mucosal cells and villi,
leading to absorption problems.
2. Extra villi cells are not created. Instead,
villi become damaged, leading to
absorption problems.
3. The intestine does not become more
porous. There is difficulty with absorbing
vitamins, leading to deficiencies, not
toxicity.
4. The child experiences diarrhea, not
constipation.
TEST-TAKING HINT: The test taker needs to
recall the pathophysiology of celiac disease
in order to select answer 1. By recalling
that the child with celiac usually appears
malnourished and experiences diarrhea, the
test taker can eliminate answers 3 and 4.
54. 1. Rye toast contains gluten.
2. Unless otherwise indicated, pancakes are
made of flour, which contains gluten.
3. Oat cereal contains gluten.
4. Cheese, banana slices, rice cakes, and
whole milk do not contain gluten.
TEST-TAKING HINT: The test taker needs to
recall that children with celiac disease
cannot tolerate gluten, which is found in
wheat, barley, rye, and oats. Answers 1, 2,
and 3 contain gluten.
55. 1. Although a blood count and serum electrolyte evaluation will likely be included
in the child’s evaluation, the diagnosis
cannot be confirmed without a stool
sample and jejuna biopsy.
2. The child is not usually kept NPO but is
monitored to assess the response to the
gluten-free diet.
3. A stool sample for analysis of fat and a
jejunal biopsy can confirm the diagnosis.
4. The child’s response to a gluten-free diet
is monitored.
TEST-TAKING HINT: The test taker should
eliminate answers 1, 2, and 4 because they
do not include preparing the child for a
jejunal biopsy, which is the key to a
definitive diagnosis of celiac disease.
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56. 1. The feedings tend to take longer and
often do not get absorbed before the next
scheduled feeding.
2. Bloody diarrhea can indicate that the
infant has NEC.
3. Bowel sounds tend to decrease, not
increase.
4. The infant does not appear hungry but
irritable.
TEST-TAKING HINT: The test taker needs to
be familiar with manifestations of NEC
and be led to select answer 2.
57. 1. The feedings should immediately be
stopped, but the NGT should be placed
to allow decompression of the stomach.
2. Vital signs should be obtained more
frequently than every 4 hours because the
infant is at high risk for peritonitis and
sepsis.
3. Intravenous antibiotics are administered to prevent or treat sepsis.
4. Feedings are stopped immediately when a
suspicion of NEC is present.
TEST-TAKING HINT: The test taker needs to
consider the plan of care for an infant with
NEC. This child is at risk for becoming
critically ill, so feedings are stopped and
vital signs are monitored very closely.
58. 1. It is thought that the breast milk contains
macrophages that help fight infection,
preventing NEC.
2. Because NEC is seen primarily in
preterm and low-birth-weight infants,
their increased survival rate has lead to an
increase in the occurrence of NEC.
3. The infant’s condition deteriorates rapidly
when sepsis occurs, so early recognition
and treatment are essential.
4. Although much more common in
preterm and low-birth-weight infants,
NEC is also seen in term infants as
well.
TEST-TAKING HINT: The test taker needs to
be familiar with general concepts associated with NEC. Answer 4 contains the
word “only,” which is an absolute value
that is rarely used in health care.
59. 1. Children with SBS experience diarrhea,
not constipation.
2. Because the intestine is used for
absorption, children with SBS usually
need alternative forms of nutrition
such as hyperalimentation.
3. Without knowing how much intestine
is involved, the nurse cannot make this
assumption about prognosis and should
not share this information with the
infant’s parents.
4. It is therapeutic to acknowledge the
parents’ concern. Without knowing the
parents’ knowledge base, this response
may or may not be above the level of
their comprehension.
TEST-TAKING HINT: The test taker should
eliminate answer 1 as it is false. Answer 3
can also be eliminated because it makes a
generalization that should not be made
without knowing the details of the child’s
diagnosis.
60. 1. It is important for children with SBS to
receive some feedings, either by tube or
mouth, so that the intestine receives some
stimulation.
2. Although TPN can cause long-term challenges, there is not an absolute time limit.
3. It is important to begin feedings as
soon as the bowel is healed so that it
receives stimulation and does not
atrophy.
4. Feedings are provided by mouth or tube
based on each child’s needs.
TEST-TAKING HINT: The test taker could
eliminate answers 1 and 4 as they contain
the word “never,” which is rarely used in
health-care scenarios.
61. 1, 2, 3, 4.
1. The lights in phototherapy increase
insensible fluid loss, requiring the
nurse to monitor fluid status closely.
2. The infant with pyloric stenosis is
likely to be dehydrated due to
persistent vomiting.
3. A 2-year-old with pneumonia may
have increased insensible fluid loss due
to tachypnea associated with respiratory illness. The nurse needs to monitor fluid status cautiously because fluid
overload can result in increased
respiratory distress.
4. The child with a burn experiences
extensive extracellular fluid loss and
is at great risk for dehydration. The
younger child is at greater risk due to
greater proportionate body surface
area.
5. An adolescent starting her menses is not
at risk for dehydration.
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TEST-TAKING HINT: The test taker needs to
know that an infant needing phototherapy,
an infant with persistent vomiting, a child
with pneumonia, and a child with burns
require more fluids because of the risk of
dehydration.
62. 1, 2, 3, 4.
1. Hypothyroidism can be a causative
factor in constipation.
2. Weakened abdominal muscles can be
seen in muscular dystrophy and can
lead to constipation.
3. Myelomeningocele affects the innervation of the rectum and can lead to
constipation.
4. Excessive milk consumption can lead
to constipation.
5. Activity tends to decrease constipation
and increase regularity.
TEST-TAKING HINT: The test taker has to
know which of these conditions can cause
constipation.
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Disorders
9
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Albuminemia
Bladder exstrophy
Cryptorchidism
Dialysate
Disequilibrium syndrome
Enuresis
Epispadias
Glomerulonephritis
Hematuria
Hemodialysis
Hydronephrosis
Hypospadias
Inguinal hernia
Peritoneal dialysis
Phimosis
Proteinuria
Reticulocyte
Testicular torsion
ABBREVIATIONS
Acute renal failure (ARF)
Blood urea nitrogen (BUN)
Chronic renal failure (CRF)
Desmopressin acetate (DDAVP)
Hemolytic uremic syndrome (HUS)
Kilogram (kg)
Milliliter (mL)
Minimal change nephrotic syndrome
(MCNS)
Magnetic resonance imaging (MRI) scan
Urinary tract infection (UTI)
Vesicoureteral reflux (VUR)
Voiding cystourethrogram (VCUG)
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QUESTIONS
1. The bladder capacity of a 3-year-old is approximately how much?
1. 1.5 fl. oz.
2. 3 fl. oz.
3. 4 fl. oz.
4. 5 fl. oz.
2. The nurse is caring for a 4-year-old who weighs 15 kg. At the end of a 10-hour
period, the nurse notes the urine output to be 150 mL. What action does the
nurse take?
1. Notifies the physician because this urine output is too low.
2. Encourages the child to increase oral intake to increase urine output.
3. Records the child’s urine output in the chart.
4. Administers isotonic fluid intravenously to help with rehydration.
3. A child had a urinary tract infection (UTI) 3 months ago and was treated with an oral
antibiotic. A follow-up urinalysis revealed normal results. The child has had no other
problems until this visit when the child was diagnosed with another UTI. Which is the
most appropriate plan?
1. Urinalysis, urine culture, and VCUG.
2. Evaluate for renal failure.
3. Admit to the pediatric unit.
4. Discharge home on an antibiotic.
4. Which should the nurse teach a group of girls and parents about the importance of
preventing urinary tract infections (UTIs)?
1. Avoiding constipation has no effect on the occurrence of UTIs.
2. After urinating, always wipe from back to front to prevent fecal contamination.
3. Hygiene is an important preventive measure and can be accomplished with
frequent tub baths.
4. Increasing fluids will help prevent and treat UTIs.
5. Which child does not need a urinalysis to evaluate for a urinary tract infection (UTI)?
1. A 4-month-old female presenting with a 2-day history of fussiness and poor
appetite; current vital signs include axillary T 100.8°F (38.2°C), HR 120 beats
per minute.
2. A 4-year-old female who states, “It hurts when I pee”; she has been urinating every
30 minutes; vital signs are within normal range.
3. An 8-year-old male presenting with a finger laceration; mother states he had
surgical reimplantation of his ureters 2 years ago.
4. A 12-year-old female complaining of pain to her lower right back; she denies any
burning or frequency at this time; oral temperature of 101.5°F (38.6°C).
6. Which is the best way to obtain a urine sample in an 8-month-old being evaluated for
a urinary tract infection (UTI)?
1. Carefully cleanse the perineum from front to back, and apply a self-adhesive urine
collection bag to the perineum.
2. Insert an indwelling Foley catheter, obtain the sample, and wait for results.
3. Place a sterile cotton ball in the diaper, and immediately obtain the sample with a
syringe after the first void.
4. Using a straight catheter, obtain the sample, and immediately remove the catheter
without waiting for the results of the urine sample.
7. Which child is at risk for developing glomerulonephritis?
1. A 3-year-old who had impetigo 1 week ago.
2. A 5-year-old with a history of five UTIs in the previous year.
3. A 6-year-old with new-onset type 1 diabetes.
4. A 10-year-old recovering from viral pneumonia.
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8. Which combination of signs is commonly associated with glomerulonephritis?
1. Massive proteinuria, hematuria, decreased urinary output, and lethargy.
2. Mild proteinuria, increased urinary output, and lethargy.
3. Mild proteinuria, hematuria, decreased urinary output, and lethargy.
4. Massive proteinuria, decreased urinary output, and hypotension.
9. The parent of a child with glomerulonephritis asks the nurse why the urine is such a
funny color. Which is the nurse’s best response?
1. “It is not uncommon for the urine to be discolored when children are receiving
steroids and blood pressure medications.”
2. “There is blood in your child’s urine that causes it to be tea-colored.”
3. “Your child’s urine is very concentrated, so it appears to be discolored.”
4. “A ketogenic diet often causes the urine to be tea-colored.”
10. Which finding requires immediate attention in a child with glomerulonephritis?
1. Sleeping most of the day and being very “cranky” when awake; blood pressure is
170/90.
2. Urine output is 190 mL in an 8-hour period and is the color of Coca-Cola.
3. Complaining of a severe headache and photophobia.
4. Refusing breakfast and lunch and stating he “just is not hungry.”
11. The parents of a child with glomerulonephritis ask how they will know their child is
improving after they go home. Which is the nurse’s best response?
1. “Your child’s urine output will increase, and the urine will become less tea-colored.”
2. “Your child will rest more comfortably as lab tests become more normal.”
3. “Your child’s appetite will decrease as urine output increases.”
4. “Your child’s laboratory values will become more normal.”
12. Which statement by a parent is most consistent with minimal change nephrotic
syndrome (MCNS)?
1. “My child missed 2 days of school last week because of a really bad cold.”
2. “After camping last week, my child’s legs were covered in bug bites.”
3. “My child came home from school a week ago due to vomiting and stomach cramps.”
4. “We have a pet turtle but no one washes their hands after playing with the turtle.”
13. The clinical manifestations of minimal change nephrotic syndrome (MCNS) are due
to which of the following?
1. Chemical changes in the composition of albumin.
2. Increased permeability of the glomeruli.
3. Obstruction of the capillaries of the glomeruli.
4. Loss of the kidney’s ability to excrete waste and concentrate urine.
14. The parents of a child hospitalized with minimal change nephrotic syndrome
(MCNS) ask why the last blood test revealed elevated lipids. Which is the nurse’s
best response?
1. “If your child had just eaten a fatty meal, the lipids may have been falsely elevated.”
2. “It’s not unusual to see elevated lipids in children because of the dietary habits of
today.”
3. “Since your child is losing so much protein, the liver is stimulated and makes
more lipids.”
4. “Your child’s blood is very concentrated because of the edema, so the lipids are
falsely elevated.”
15. A child with minimal change nephrotic syndrome (MCNS) has generalized edema.
The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. Which does
the nurse expect to be included in the treatment plan to reduce edema?
1. An increase in the amount and frequency of Lasix.
2. Addition of a second diuretic, such as mannitol.
3. Administration of intravenous albumin.
4. Elimination of all fluids and sodium from the child’s diet.
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16. A parent asks the nurse how to prevent the child from having minimal change
nephrotic syndrome (MCNS) again. Which is the nurse’s best response?
1. “It is very rare for a child to have a relapse after having fully recovered.”
2. “Unfortunately, many children have cycles of relapses, and there is very little that
can be done to prevent it.”
3. “Your child is much less likely to get sick again if sodium is decreased in the diet.”
4. “Try to keep your child away from sick children because relapses have been
associated with infectious illnesses.”
17. The nurse is caring for a newborn with hypospadias. His parents ask if circumcision
is an option. Which is the nurse’s best response?
1. “Circumcision is a fading practice and is now contraindicated in most children.”
2. “Circumcision in children with hypospadias is recommended because it helps
prevent infection.”
3. “Circumcision is an option, but it cannot be done at this time.”
4. “Circumcision can never be performed in a child with hypospadias.”
18. An infant is scheduled for a hypospadias and chordee repair. The parent tells the
nurse, “I understand why the hypospadias repair is necessary, but do they have to fix
the chordee as well?” Which is the nurse’s best response?
1. “I understand your concern. Parents do not want their children to undergo extra
surgery.”
2. “The chordee repair is done strictly for cosmetic reasons that may affect your son
as he ages.”
3. “The repair is done to optimize sexual functioning when he is older.”
4. “This is the best time to repair the chordee because he will be having surgery
anyway.”
19. A 13-month-old is discharged following repair of his epispadias. Which statement
made by the parents indicates they understand the discharge teaching?
1. “If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to
prevent a blockage.”
2. “If a mucous plug forms in the urinary drainage tube, we will allow it to pass on
its own because this is a sign of healing.”
3. “We will make sure the dressing is loosely applied to increase the toddler’s
comfort.”
4. “If we notice any yellow drainage, we will know that everything is healing well.”
20. Which would the nurse most likely find in the history of a child with hemolytic
uremic syndrome (HUS)?
1. Frequent UTIs and possible vesicoureteral reflux (VUR).
2. Vomiting and diarrhea before admission.
3. Bee sting and localized edema of the site for 3 days.
4. Previously healthy and no signs of illness.
21. The manifestations of hemolytic uremic syndrome (HUS) are due primarily to which
event?
1. The swollen lining of the small blood vessels damages the red blood cells, which
are then removed by the spleen, leading to anemia.
2. There is a disturbance of the glomerular basement membrane, allowing large
proteins to pass through.
3. The red blood cell changes shape, causing it to obstruct microcirculation.
4. There is a depression in the production of all formed elements of the blood.
22. Which laboratory results besides hematuria are most consistent with hemolytic
uremic syndrome (HUS)?
1. Massive proteinuria, elevated blood urea nitrogen, and creatinine.
2. Mild proteinuria, decreased blood urea nitrogen, and creatinine.
3. Mild proteinuria, increased blood urea nitrogen, and creatinine.
4. Massive proteinuria, decreased blood urea nitrogen, and creatinine.
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23. A child with hemolytic uremic syndrome (HUS) is very pale and lethargic. Stools
have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The
nurse expects administration of blood products and what else to be added to the plan
of care?
1. Initiation of dialysis.
2. Close observation of the child’s hemodynamic status.
3. Diuretic therapy to force urinary output.
4. Monitoring of urinary output.
24. Which needs to be present to diagnose hemolytic uremic syndrome (HUS)?
1. Increased red blood cells with a low reticulocyte count, increased platelet count,
and renal failure.
2. Decreased red blood cells with a high reticulocyte count, decreased platelet count,
and renal failure.
3. Increased red blood cells with a high reticulocyte count, increased platelet count,
and renal failure.
4. Decreased red blood cells with a low reticulocyte count, decreased platelet count,
and renal failure.
25. A 5-year-old is discharged from the hospital following the diagnosis of hemolytic
uremic syndrome (HUS). The child has been free of diarrhea for 1 week, and renal
function has returned. The parent asks the nurse when the child can return to
school. Which is the nurse’s best response?
1. “Immediately, as your child is no longer contagious.”
2. “It would be best to keep your child home for a few more weeks because the
immune system is weak, and there could be a relapse of HUS.”
3. “Your child will be contagious for approximately another 10 days, so it is best to
not allow a return just yet.”
4. “It would be best to keep your child home to monitor urinary output.”
26. Which is a care priority for a newborn diagnosed with bladder exstrophy and a
malformed pelvis?
1. Change the diaper frequently and assess for skin breakdown.
2. Keep the exposed bladder open in a warm and dry environment to avoid any
heat loss.
3. Offer formula for infant growth and fluid management.
4. Cluster all care to allow the child to sleep, grow, and gain strength for the upcoming
surgical repair.
27. Which medication would most likely be included in the post-operative care of a child
with repair of bladder exstrophy?
1. Lasix.
2. Mannitol.
3. Meperidine.
4. Oxybutynin.
28. The nurse is providing discharge instructions to the parents of an infant born with
bladder exstrophy who had a continent urinary reservoir placed. Which statement
should be included?
1. “Allow your child to sleep on the abdomen to provide comfort during the immediate
post-operative period.”
2. “As your child grows, be cautious around playgrounds because the surface could
be a health hazard.”
3. “As your child grows, be sure to encourage many different foods because it is not
likely that food allergies will develop.”
4. “Encourage your child’s development, by having brightly colored objects around,
such as balloons.”
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29. Which causes the clinical manifestations of hydronephrosis?
1. A structural abnormality in the urinary system causes urine to back up and can
cause pressure and cell death.
2. A structural abnormality causes urine to flow too freely through the urinary
system, leading to fluid and electrolyte imbalances.
3. Decreased production of urine in one or both kidneys results in an electrolyte
imbalance.
4. Urine with an abnormal electrolyte balance and concentration leads to increased
blood pressure and subsequent increased glomerular filtration rate.
30. In addition to increased blood pressure, which findings would most likely be found in
a child with hydronephrosis?
1. Metabolic alkalosis, polydipsia, and polyuria.
2. Metabolic acidosis, and bacterial growth in the urine.
3. Metabolic alkalosis, and bacterial growth in the urine.
4. Metabolic acidosis, polydipsia, and polyuria.
31. Which should be included in the plan of care for a child diagnosed with hydronephrosis?
1. Intake and output as well as vital signs should be strictly monitored.
2. Fluids and sodium in the diet should be limited.
3. Steroids should be administered as ordered.
4. Limited contact with other people to avoid infection.
32. The nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had
trouble maintaining blood glucose levels within normal limits. The child’s parent
states the child has had several daytime “accidents.” The nurse knows that this is
referred to as which of the following?
1. Primary enuresis.
2. Secondary enuresis.
3. Diurnal enuresis.
4. Nocturnal enuresis.
33. The parent of a 7-year-old voices concern over the child’s continued bed-wetting at
night. The parent, on going to bed, has tried getting the child up at 11:30 p.m., but
the child still wakes up wet. Which is the nurse’s best response about what the parent
should do next?
1. “There is a medication called DDAVP that decreases the volume of the urine.
The physician thinks that will work for your child.”
2. “When your child wakes up wet, be very firm, and indicate how displeased you
are. Have your child change the sheets to see how much work is involved.”
3. “Limit fluids in the evening, and start a reward system in which your child can
choose a reward after a certain number of dry nights.”
4. “Bed-wetting alarms are readily available, and most children do very well with
them.”
34. An adolescent woke up complaining of intense pain and swelling of the scrotal area
and abdominal pain. He has vomited twice. Which should the nurse suggest?
1. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse,
bring him to the emergency room.
2. Bring him to the pediatrician’s office for evaluation.
3. Take him to the emergency room immediately.
4. Encourage him to rest; apply ice to the scrotal area, and go to the emergency
room if the pain does not improve.
35. Which causes the symptoms in testicular torsion?
1. Twisting of the spermatic cord interrupts the blood supply.
2. Swelling of the scrotal sac leads to testicular displacement.
3. Unmanaged undescended testes cause testicular displacement.
4. Microthrombi formation in the vessels of the spermatic cord causes interruption
of the blood supply.
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36. The nurse evaluates post-operative teaching for repair of testicular torsion as successful
when the parent of an adolescent says which the following?
1. “I will encourage him to rest for a few days, but he can return to football practice
in a week.”
2. “I will keep him in bed for 4 days and let him gradually increase his activity after
that.”
3. “I will seek therapy as he ages because he is now infertile.”
4. “I will make sure he does testicular self-examination monthly.”
37. Which protrusion into the groin of a female most likely causes inguinal hernias?
1. Bowel.
2. Fallopian tube.
3. Large thrombus formation.
4. Muscle tissue.
38. The parents of a 6-week-old male ask the nurse if there is a difference between an
inguinal hernia and a hydrocele. Which is the nurse’s best response?
1. “The terms are used interchangeably and mean the same thing.”
2. “The symptoms are similar, but an inguinal hernia occurs when tissue protrudes
into the groin, whereas a hydrocele is a fluid-filled mass in the scrotum.”
3. “A hydrocele is the term used when an inguinal hernia occurs in females.”
4. “A hydrocele presents in a manner similar to that of an inguinal hernia but causes
increased concern because it is often malignant.”
39. The nurse evaluates the parents’ understanding of the teaching about an inguinal
hernia as successful when they say which of the following?
1. “There are no risks associated with waiting to have the hernia reduced; surgery is
done for cosmetic reasons.”
2. “It is normal to see the bulge in the baby’s groin decrease with a bowel movement.”
3. “We will wait for surgery until the baby is older because narcotics for pain control
will be required for several days.”
4. “It is normal for the bulge in the baby’s groin to look smaller when the baby is
asleep.”
40. Which would the nurse expect to hear the parents of an infant with an incarcerated
hernia report?
1. Acute onset of pain, abdominal distention, and a mass that cannot be reduced.
2. Gradual onset of pain, abdominal distention, and a mass that cannot be reduced.
3. Acute onset of pain, abdominal distention, and a mass that is easily reduced.
4. Gradual onset of pain, abdominal distention, and a mass that is easily reduced.
41. The parent of a 3-year-old is shocked to hear the diagnosis of Wilms tumor and says,
“How could I have missed a lump this big?” Which is the nurse’s best response?
1. “Do not be hard on yourself. It’s easy to overlook something that has probably
been growing for months when we see our children on a regular basis.”
2. “I understand you must be very upset. Your child would have had a better prognosis
had you caught it earlier.”
3. “It really takes a trained professional to recognize something like this.”
4. “Do not blame yourself. This mass grows so fast that it was probably not noticeable
a few days ago.”
42. Which would the nurse expect to find on assessment in a child with Wilms tumor?
1. Decreased blood pressure, increased temperature, and a firm mass located in one
flank area.
2. Increased blood pressure, normal temperature, and a firm mass located in one
flank area.
3. Increased blood pressure, normal temperature, and a firm mass located on one
side of the midline of the abdomen.
4. Decreased blood pressure, normal temperature, and a firm mass located on one
side or the other of the midline of the abdomen.
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43. A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs.
The parent asks the nurse the reason for this test as a Wilms tumor involves the
kidney, not the lung. Which is the nurse’s best response?
1. “I’m not sure why your child is going for this test. I will check and get back to
you.”
2. “It sounds like we made a mistake. I will check and get back to you.”
3. “The test is done to check to see if the disease has spread to the lungs.”
4. “We want to check the lungs to make sure your child is healthy enough to tolerate
surgery.”
44. The parents overhear the health-care team refer to their child’s disease as in stage III.
The parents ask the nurse what this means. Which is the nurse’s best response?
1. The tumor is confined to the abdomen, but it has spread to the lymph nodes or
peritoneal area; the prognosis is poor.
2. The tumor is confined to the abdomen, but it has spread to the lymph nodes or
peritoneal area; the prognosis is very good.
3. The tumor has been found in three other organs beyond the peritoneal area; the
prognosis is good.
4. The tumor has spread to other organs beyond the peritoneal area; the prognosis is
poor.
45. The nurse is caring for a child due for surgery on a Wilms tumor. The child’s procedure
will consist of which of the following?
1. Only the affected kidney will be removed.
2. Both the affected kidney and the other kidney will be removed in case of recurrence.
3. The mass will be removed from the affected kidney.
4. The mass will be removed from the affected kidney, and a biopsy of the tissue of
the unaffected kidney will be done.
46. The nurse anticipates that the child who has had a kidney removed will have a high
level of pain and will require invasive and noninvasive measures for pain relief. The
nurse anticipates that the child will have pain because of which of the following?
1. The kidney is removed laparoscopically, and there will be residual pain from
accumulated air in the abdomen.
2. There is a post-operative shift of fluids and organs in the abdominal cavity,
leading to increased discomfort.
3. The chemotherapy makes the child more sensitive to pain.
4. The radiation therapy makes the child more sensitive to pain.
47. The parents of a 7-year-old tell the nurse they do not understand the difference between chronic renal failure (CRF) and acute renal failure (ARF). Which is the nurse’s
best response?
1. “There really is not much difference because the terms are used interchangeably.”
2. “Most children experience ARF. It is highly unusual for a child to experience
CRF.”
3. “CRF tends to occur suddenly and is irreversible.”
4. “ARF is often reversible, whereas CRF results in permanent deterioration of
kidney function.”
48. A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours
ago due to post-operative hemorrhage. The parent noted that her child was “swallowing a lot and finally began vomiting large amounts of blood.” The child’s vital
signs are as follows: T 99.5°F (37.5°C), HR 124, BP 84/48, and RR 26. The nurse
knows that this child is at risk for which type of renal failure?
1. CRF due to advanced disease process.
2. Prerenal failure due to dehydration.
3. Primary kidney damage due to a lack of urine flowing through the system.
4. Postrenal failure due to a hypotensive state.
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49. A child diagnosed with acute renal failure (ARF) complains of “not feeling well,”
having “butterflies in the chest,” and arms and legs “feeling like Jell-O.” The cardiac
monitor shows that the QRS complex is wider than before and that an occasional
premature ventricular contraction (PVC) is seen. Which would the nurse expect to
administer?
1. An isotonic saline solution with 20 mEq KCl/L.
2. Sodium bicarbonate via slow intravenous push.
3. Calcium gluconate via slow intravenous push.
4. Oral potassium supplements.
50. A 10-kg toddler is diagnosed with acute renal failure (ARF), is afebrile, and has a
24-hour urine output of 110 mL. After calculating daily fluid maintenance, which
would the nurse expect the toddler’s daily allotment of fluids to be?
1. Sips of clear fluids and ice chips only.
2. 350 mL of oral and intravenous fluids.
3. 1000 mL of oral and intravenous fluids.
4. 2000 mL of oral and intravenous fluids.
51. The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema
is noted throughout the child’s body, and the liver is enlarged. The child’s urine output is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and
RR 42. The child is noted to have nasal flaring and retractions with inspiration. The
lung sounds are coarse throughout. Despite receiving oral Kayexalate, the child’s
serum potassium continues to rise. Which treatment will provide the most benefit to
the child?
1. Additional rectal Kayexalate.
2. Intravenous furosemide.
3. Endotracheal intubation and ventilatory assistance.
4. Placement of a Tenckhoff catheter for peritoneal dialysis.
52. The parent of a child diagnosed with acute renal failure (ARF) asks the nurse why
peritoneal dialysis was selected instead of hemodialysis. Which is the nurse’s best
response?
1. “Hemodialysis is not used in the pediatric population.”
2. “Peritoneal dialysis has no complications, so it is a treatment used without hesitation.”
3. “Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many
complications are avoided.”
4. “Peritoneal dialysis is much more efficient than hemodialysis.”
53. The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes
the return to be cloudy, and the child is complaining of abdominal pain. The child’s
parents ask what the next step will likely be. Which is the nurse’s best response?
1. “We will probably place antibiotics in the dialysis fluid before the next dwell time.”
2. “Many children experience cloudy returns. We do not usually worry about it.”
3. “We will probably give your child some oral antibiotics just to make sure nothing
else develops.”
4. “The abdominal pain is likely due to the fluid going in too slowly. We will increase
the rate of administration with the next fill.”
54. A child receiving peritoneal dialysis has not been having adequate volume in the
return. The child is currently edematous and hypertensive. Which would the nurse
anticipate the physician to do?
1. Increase the glucose concentration of the dialysate.
2. Decrease the glucose concentration of the dialysate.
3. Administer antihypertensives and diuretics but not change the dialysate concentration.
4. Decrease the dwell time of the dialysate.
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55. During hemodialysis, the nurse notes that a 10-year-old becomes confused and
restless. The child complains of a headache and nausea and has generalized muscle
twitching. This can be prevented by which of the following?
1. Slowing the rate of solute removal during dialysis.
2. Ensuring the patient is warm during dialysis.
3. Administering antibiotics before dialysis.
4. Obtaining an accurate weight the night before dialysis.
56. Chronic hypertension in the child who has chronic renal failure (CRF) is due to
which of the following?
1. Retention of sodium and water.
2. Obstruction of the urinary system.
3. Accumulation of waste products in the body.
4. Generalized metabolic alkalosis.
57. Which best describes the electrolyte imbalance that occurs in chronic renal failure
(CRF)?
1. Decreased serum phosphorus and calcium levels.
2. Depletion of phosphorus and calcium stores from the bones.
3. Change in the structure of the bones, causing calcium to remain in the bones.
4. Nutritional needs are poorly met, leading to a decrease in many electrolytes such
as calcium and phosphorus.
58. The diet for a child with chronic renal failure (CRF) should be high in calories and
include:
1. Low protein, and all minerals and electrolytes.
2. Low protein and minerals.
3. High protein and calcium and low potassium and phosphorus.
4. High protein, phosphorus, and calcium and low potassium and sodium.
59. One week after kidney transplant, a child complains about abdominal pain, and the
parents note that the child has been very irritable. The nurse notes a 10% weight gain
as well as elevated BUN and creatinine levels. Which of the following medications
would the child most likely be taking?
1. Codeine tablets.
2. Furosemide.
3. MiraLAX powder.
4. Corticosteroids.
60. A renal transplantation is which of the following?
1. A curative procedure that will free the child from any more treatment modalities.
2. An ideal treatment option for families with a history of dialysis noncompliance.
3. A treatment option that will free the child from dialysis.
4. A treatment option that is very new to the pediatric population.
61. The parents of a 3-year-old are concerned that the child is having “more accidents”
during the day. Which question would be appropriate for the nurse to ask to obtain
more information? Select all that apply.
1. “Has there been a stressful event in the child’s life, such as the birth of a sibling?”
2. “Has anyone else in the family had problems with accidents?”
3. “Does your child seem to be drinking more than usual?”
4. “Is your child more irritable, and does your child seem to be in pain when urinating?”
5. “Is your child having difficulties at preschool?”
62. Which is true of a Wilms tumor? Select all that apply.
1. It is also referred to as neuroblastoma.
2. It can occur at any age but is seen most often between the ages of 2 and 5 years.
3. It can occur on its own or can be associated with many congenital anomalies.
4. It is a slow-growing tumor.
5. It is associated with a very poor prognosis.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. The capacity of the bladder in fluid ounces
can be estimated by adding 2 to the child’s
age in years.
2. The capacity of the bladder in fluid ounces
can be estimated by adding 2 to the child’s
age in years.
3. The capacity of the bladder in fluid ounces
can be estimated by adding 2 to the child’s
age in years.
4. The capacity of the bladder in fluid
ounces can be estimated by adding
2 to the child’s age in years.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because 1.5 fl oz
represents a very small bladder capacity.
2. 1. The child weighs 15 kg, and the expected
urine output is 0.5–1 mL/kg/hr. 0.5 ⫻ 15 kg =
7.5 mL; 1 mL ⫻ 15 kg = 15 mL. 7.5–15
mL/hour ⫻ 10 hours = 75–150 mL of urine
for the 10-hour period. Therefore, the output
is not too low.
2. The child weighs 15 kg, and the expected
urine output is 0.5–1 mL/kg/hr. 0.5 ⫻
15 kg = 7.5 mL; 1 mL ⫻ 15 kg = 15 mL.
7.5–15 mL/hour ⫻ 10 hours = 75–150 mL
of urine for the 10-hour period. Therefore,
the output is not too low.
3. Recording the child’s urine output in
the chart is the appropriate action
because the urine output is within the
expected range of 0.5–1 mL/kg/hr, or
75–150 mL for the 10-hour period.
4. The child weighs 15 kg and the expected
urine output is 0.5–1 mL/kg/hr. 0.5 ⫻
15 kg = 7.5 mL; 1 mL ⫻ 15 kg = 15 mL.
7.5–15 mL/hour ⫻ 10 hours = 75–150 mL
of urine for the 10-hour period. Therefore, it is not too low.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 4 because
they address strategies for caring for a
dehydrated child.
3. 1. Urinalysis and urine culture are routinely used to diagnose UTIs. VCUG is
used to determine the extent of urinary
tract involvement when a child has a
second UTI within 1 year.
2. There are no data to suggest that renal
failure should be evaluated.
3. A UTI is usually treated with oral antibiotics at home, not routinely requiring
admission to the hospital.
4. A second UTI requires more extensive
evaluation and diagnostic testing.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because it is the only
answer that does not address the UTI.
Answer 1 is the best choice because it will
provide more data about the cause of the
child’s recurrent UTIs.
4. 1. The increased pressure associated with
evacuating the hardened stool can result in
the backflow of urine into the bladder,
leading to infection.
2. To prevent infection, a female child should
wipe from front to back.
3. Tub baths are not recommended because
they may cause irritation of the urethra,
leading to infection.
4. Increasing fluids will help flush the
bladder of any organism, encourage
urination, and prevent stasis of urine.
TEST-TAKING HINT: The test taker can
eliminate answers 1, 2, and 3 because they
do not provide accurate information.
5. 1. Fussiness and lack of appetite can indicate a
UTI. Signs of infection, such as fever and
increased heart rate, should be evaluated to
determine whether an infection exists.
2. Frequency and urgency are classic signs
of a UTI.
3. Although this child has had a history of
urinary infections, the child is currently
not displaying any signs and therefore
does not need a urinalysis at this time.
4. Pain to the lower right back can indicate
infection of the upper urinary tract. Although
the child currently denies any burning or
frequency, the child currently has a fever coupled with flank pain, which needs evaluation.
TEST-TAKING HINT: The test taker should
be led to answer 3 because it states that
the child is not currently having any
manifestations of a UTI.
6. 1. A sample obtained from a urine bag would
contain microorganisms from the skin,
causing contamination of the sample.
2. There is no need to leave the catheter in
because it serves as a portal for infection.
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3. The cotton ball would not remain sterile and
would therefore contaminate the urine sample.
4. An in-and-out catheterization is the
best way to obtain a urine culture in a
child who is not yet toilet-trained.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 3 because they
both lead to a contaminated sample.
7. 1. Impetigo is a skin infection caused by the
streptococcal organism that is commonly
associated with glomerulonephritis.
2. Frequent UTIs have not been associated
with glomerulonephritis.
3. Type 1 diabetes is not a cause of glomerulonephritis.
4. Glomerulonephritis can be caused by a streptococcal organism, not a viral pneumonia.
TEST-TAKING HINT: The test taker may be
distracted by answer 4, but that choice
is a viral infection so that makes it an
incorrect choice.
8. 1. Unlike nephrotic syndrome, protein is
lost in mild-to-moderate amounts.
2. Urinary output is decreased in the child
with glomerulonephritis.
3. Mild-to-moderate proteinuria, hematuria,
decreased urinary output, and lethargy are
common findings in glomerulonephritis.
4. Hypertension, not hypotension, is a
common finding in glomerulonephritis.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 4 because
glomerulonephritis does not cause massive proteinuria. Answer 2 can be eliminated because increased urine output is
not associated with glomerulonephritis.
9. 1. Steroids and antihypertensives do not
cause urine to change color.
2. Blood in the child’s urine causes it to
be tea-colored.
3. The tea color of the urine is due to hematuria, not concentration.
4. The child with glomerulonephritis is not
on a ketogenic diet. The ketogenic diet
does not cause the urine to change color.
TEST-TAKING HINT: The test taker can immediately eliminate answer 4 because the
child is not placed on a ketogenic diet.
10. 1. Children with glomerulonephritis usually
have an elevated blood pressure and tend
to rest most of the day.
2. The urine output is often decreased, and
the urine is often tea-colored due to
hematuria.
3. A severe headache and photophobia
can be signs of encephalopathy due to
hypertension, and the child needs
immediate attention.
4. Anorexia is often seen with glomerulonephritis.
TEST-TAKING HINT: The test taker should
eliminate answers 1, 2, and 4 because they
are manifestations of glomerulonephritis.
11. 1. When glomerulonephritis is improving, urine output increases, and the
urine becomes less tea-colored. These
are signs that can be monitored at
home by the child’s parents.
2. As glomerulonephritis improves, the child
should have more energy and rest less.
3. The child’s appetite should increase as the
condition improves.
4. Although the laboratory test values will
normalize, this is not something that
will be readily apparent to the family
at home.
TEST-TAKING HINT: The test taker should
be led to answer 1 because the manifestations represent improvement in the
disease process that can be easily
recognized by the parents.
12. 1. An upper respiratory infection often
precedes MCNS by a few days.
2. Bug bites are not typically associated with
MCNS.
3. Vomiting and abdominal cramping are
not typically associated with MCNS.
4. Pet turtles often carry salmonella, which
can cause vomiting and diarrhea but not
MCNS.
TEST-TAKING HINT: The test taker should
be led to answer 1 because MCNS is most
often associated with upper respiratory
infections.
13. 1. Albumin does not undergo any chemical
changes in MCNS.
2. Increased permeability of the
glomeruli in MCNS allows large
substances such as protein to pass
through and be excreted in the urine.
3. Obstruction of the capillaries of the
glomeruli due to the formation of
antibody-antigen complexes occurs in
glomerulonephritis.
4. Loss of the kidneys’ ability to excrete
waste and concentrate urine occurs in
renal failure.
TEST-TAKING HINT: The test taker should
recognize the pathophysiology of MCNS.
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CHAPTER 9 GENITOURINARY DISORDERS
14. 1. In MCNS, the lipids are truly elevated.
Lipoprotein production is increased
because of the increased stimulation of
the liver hypoalbuminemia.
2. The elevated lipids are unrelated to the
child’s dietary habits.
3. In MCNS, the lipids are truly elevated.
Lipoprotein production is increased
because of the increased stimulation of
the liver hypoalbuminemia.
4. The lipids are not falsely elevated.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 2 because they do
not represent changes associated with a
disease process.
15. 1. The dosage of the diuretic may be
adjusted, but other medications such
as albumin are likely to be used.
2. Mannitol is not usually used in the
treatment of MCNS.
3. In cases of severe edema, albumin is
used to help return the fluid to the
bloodstream from the subcutaneous
tissue.
4. Although sodium and fluids are restricted
in the severely edematous child, they are
not eliminated completely.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because mannitol is
used to treat cerebral edema.
16. 1. It is not unusual for a child to experience
relapses.
2. Many children do experience relapses, but
exposure to infectious illnesses has been
linked to relapses.
3. There is no correlation between the
consumption of sodium and nephrotic
syndrome.
4. Exposure to infectious illness has been
linked to the relapse of nephrotic
syndrome.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 2 because relapses
are common and can be prevented.
17. 1. Routine circumcision is recommended by
the American Academy of Pediatrics; it is
not contraindicated in most children.
2. It is not recommended that circumcision
of children with hypospadias be done
immediately because the foreskin may be
needed later for repair of the defect.
3. It is usually recommended that
circumcision be delayed in the child
with hypospadias because the foreskin
may be needed for repair of the defect.
4. Circumcision can usually be performed
in the child with hypospadias when the
defect is corrected.
TEST-TAKING HINT: The test taker can
eliminate answer 4 because “never” is
infrequently the case in health care.
18. 1. This response is empathetic. It does not,
however, answer the parent’s concern,
whereas a simple explanation would
immediately do so.
2. Although a cosmetic component exists,
straightening the penis is important for
future sexual function.
3. Releasing the chordee surgically is
necessary for future sexual function.
4. Although the two surgeries are usually
done simultaneously, each has its own
importance and necessity.
TEST-TAKING HINT: The test taker should be
led to answer 3 because it provides the
parents with a simple, accurate explanation.
19. 1. Any mucous plugs should be removed
by irrigation to prevent blockage of
the urinary drainage system.
2. The mucous plug should be removed by
irrigation because it could cause a
blockage of the urinary drainage system.
3. The dressing is usually a compression type
of dressing that helps decrease edema.
4. Foul-smelling yellow drainage is often a
sign of infection that needs to be evaluated.
TEST-TAKING HINT: The test taker can
eliminate answer 2 and 4 because they
have potential to cause injury to the child.
20. 1. Frequent UTIs and VUR do not lead to
HUS.
2. HUS is often preceded by diarrhea
that may be caused by E. coli present
in undercooked meat.
3. Insect stings are not associated with HUS.
4. HUS is usually preceded by diarrhea.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because there is no
correlation between UTIs and HUS.
21. 1. The swollen lining of the small
blood vessels damages the red blood
cells, which are then removed by
the spleen.
2. The increased permeability of the
basement membrane occurs in MCNS.
3. The red blood cell changing shape is
typical of sickle cell anemia.
4. The depression of all formed elements of
the blood occurs in aplastic anemia.
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TEST-TAKING HINT: The question requires
familiarity with the pathophysiology
of HUS.
22. 1. Protein is not lost in massive amounts
in HUS.
2. BUN and creatinine are usually increased
in HUS.
3. Hematuria, mild proteinuria, increased
BUN, and creatinine are all present
in HUS.
4. Protein is not lost in massive amounts in
HUS.
TEST-TAKING HINT: The test taker can
eliminate answer 4 because ketonuria is
not associated with HUS.
23. 1. Because the child is symptomatic,
dialysis is the treatment of choice.
2. Because the child is symptomatic, dialysis
is the treatment of choice.
3. Diuretics are given to prevent fluid
overload, but they cannot cause the
child in renal failure to produce urine.
4. Clotting factors are not used in HUS.
The nurse would expect the plan to
include dialysis, because the child is no
longer producing urine.
TEST-TAKING HINT: The test taker can
eliminate answer 3 because diuretics
will not cause a child in renal failure
to produce urine.
24. 1. The triad in HUS includes decreased red
blood cells (with a high reticulocyte count
as the body attempts to produce more red
blood cells), decreased platelet count, and
renal failure.
2. The triad in HUS includes decreased
red blood cells (with a high reticulocyte count as the body attempts to
produce more red blood cells),
decreased platelet count, and renal
failure.
3. The triad in HUS includes decreased red
blood cells (with a high reticulocyte count
as the body attempts to produce more red
blood cells), decreased platelet count, and
renal failure.
4. The triad in HUS includes decreased red
blood cells (with a high reticulocyte count
as the body attempts to produce more red
blood cells), decreased platelet count, and
renal failure.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 3 because
platelets are not increased in HUS.
25. 1. Children with HUS are considered
contagious for up to 17 days after the
resolution of diarrhea and should be
placed on contact isolation.
2. Once the child recovers from HUS, there
is usually no relapse.
3. Children with HUS are considered
contagious for up to 17 days after the
resolution of diarrhea and should be
placed on contact isolation.
4. Once free of diarrhea for approximately
17 days, the child is considered not to be
contagious and should be encouraged to
return to developmentally appropriate
activities as tolerated.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because the child is
still considered contagious.
26. 1. Preventing infection from stool
contamination and skin breakdown
is the top priority of care.
2. The bladder should be covered with a
moist dressing and not kept open where it
can be exposed to pathogens or subject to
irritation from drying.
3. Infant formula would not provide enough
fluid for this infant. An umbilical artery
catheter would be inserted to provide
fluids because of large insensible fluid
losses from the exposed viscera.
4. Although the child should be encouraged
to rest, it is important to change the
diaper immediately to prevent fecal
contamination and subsequent infection.
TEST-TAKING HINT: The test taker can
eliminate answers 2 and 3 because they
have potential to cause harm to the infant.
27. 1. Lasix is a loop diuretic that is not
routinely used in the care of the child
with a repair of bladder exstrophy.
2. Mannitol is an osmotic diuretic that is not
routinely used in the care of the child
with a repair of bladder exstrophy.
3. Meperidine is a narcotic that is not a
first-line drug for pain management after
a bladder reconstruction.
4. Oxybutynin is used to control bladder
spasms.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because mannitol is a
diuretic that is used for central nervous
system edema.
28. 1. The infant should not be allowed to
sleep on the abdomen because the prone
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position has been associated with sudden
infant death syndrome.
2. Many children with urological malformations are prone to latex allergies.
The surfaces of playgrounds are often
made of rubber, which contains latex.
3. Many children with urological malformations are prone to latex allergies. Foods
such as bananas can cause a latex allergy.
4. Although children need a stimulating
environment, balloons are dangerous
because many contain latex and can also
be a choking hazard.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because infants should
be placed to sleep on their backs to
prevent sudden infant death syndrome.
29. 1. Hydronephrosis is due to a structural
abnormality in the urinary system,
causing urine to back up, leading to
pressure and potential cell death.
2. Hydronephrosis is due to pressure created
by an obstruction, causing urine to back
up. There is no free flow of urine.
3. A decreased production of urine does not
lead to hydronephrosis.
4. Hydronephrosis is not caused by
abnormalities in the urine.
TEST-TAKING HINT: This question requires
familiarity with the pathophysiology of
hydronephrosis.
30. 1. The blood pressure is increased as the
body attempts to compensate for the
decreased glomerular filtration rate.
Polydipsia and polyuria occur as the
kidney’s ability to concentrate urine
decreases. Metabolic acidosis occurs, not
alkalosis.
2. The blood pressure is increased as the
body attempts to compensate for the
decreased glomerular filtration rate.
Metabolic acidosis occurs because there
is a reduction in hydrogen ion secretion
from the distal nephron. There is bacterial growth in the urine due to the urinary
stasis caused by the obstruction.
3. The blood pressure is increased as the
body attempts to compensate for the
decreased glomerular filtration rate.
Metabolic acidosis, not alkalosis, occurs
because there is a reduction in hydrogen
ion secretion from the distal nephron.
There is bacterial growth in the urine
due to the urinary stasis caused by the
obstruction.
4. The blood pressure is increased as the
body attempts to compensate for the
decreased glomerular filtration rate.
Metabolic acidosis is caused by a
reduction in hydrogen ion secretion
from the distal nephron. Polydipsia
and polyuria occur as the kidney’s
ability to concentrate urine decreases.
There is bacterial growth in the urine
due to the urinary stasis caused by the
obstruction.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 3 because
hydronephrosis does not lead to
metabolic alkalosis.
31. 1. Fluid status is monitored to ensure
adequate urinary output. Assessing blood
pressure monitors kidney function.
2. Fluid and sodium restriction are not
required in hydronephrosis.
3. Steroids are not routinely used in the
treatment of hydronephrosis.
4. Limiting the child’s exposure to other
people does not help prevent UTIs.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because fluids and
sodium are not eliminated from the
child’s diet.
32. 1. Primary enuresis refers to urinary incontinence in a child who has never had
voluntary bladder control.
2. Secondary enuresis refers to urinary
incontinence in a child who previously
had bladder control.
3. Diurnal enuresis refers to daytime urinary
incontinence not caused by something else.
4. Nocturnal enuresis refers to nighttime
urinary incontinence.
TEST-TAKING HINT: The test taker should
be led to answer 2 because the enuresis is
secondary to something else, in this case a
disease process.
33. 1. Although DDAVP is used for enuresis, it
is not the first treatment chosen. Behavior
modification and positive reinforcement
are usually tried first.
2. Having the child help with changing the
bed is a good idea. The child should be
approached in a positive manner, however,
not a punitive one, so as not to threaten
self-esteem.
3. Limiting the child’s fluids in the
evening will help decrease the nocturnal urge to void. Providing positive
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reinforcement and allowing the child
to choose a reward will increase the
child’s sense of control.
4. Enuresis alarms are readily available, but
behavior modification and positive
reinforcement are usually tried first.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because negative
reinforcement is not recommended and
is not helpful.
34. 1. The child is having symptoms of testicular torsion, which is a surgical emergency
and needs immediate attention. The child
should not wait to go to the emergency
room and should be told not to drink
anything in anticipation of surgery.
2. Testicular torsion is a surgical emergency,
and time should not be wasted at the pediatrician’s office when the child needs surgery.
3. The child is having symptoms of
testicular torsion, which is a surgical
emergency and needs immediate
attention.
4. The child should be brought to the
emergency room immediately because
testicular torsion is a surgical emergency.
Ice and scrotal support can be used for
relief of discomfort, but bringing the child
to the emergency room is the priority.
TEST-TAKING HINT: The test taker should
be led to answer 3 because testicular
torsion is a surgical emergency.
35. 1. Testicular torsion is caused by an
interruption of the blood supply due
to twisting of the spermatic cord.
2. Swelling of the scrotal sac occurs because
of testicular torsion; it is not a cause of
testicular torsion.
3. Unmanaged undescended testes may be
a risk factor but not a cause of testicular
torsion.
4. Microthrombi formation in the vessels
of the spermatic cord does not occur in
testicular torsion.
TEST-TAKING HINT: This question depends
on familiarity with the pathophysiology of
testicular torsion.
36. 1. Lifting and strenuous activity should be
avoided for 2 to 4 weeks.
2. The child should not be placed on bedrest
and should be encouraged to gradually
increase activity while resting as necessary.
3. Most cases of testicular torsion involve
only one testis, so most children do not
become infertile.
4. The child and family should be
taught the importance of testicular
self-examination.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because this activity
could place the post-operative child at
risk for injury.
37. 1. Bowel is the most common tissue to
protrude into the groin in males.
2. Fallopian tube or an ovary is the most
common tissue to protrude into the
groin in females.
3. Large thrombus formation does not
commonly protrude into the groin.
4. Muscle tissue does not commonly
protrude into the groin.
TEST-TAKING HINT: The test taker should
be led to answer 2 because the question
specifically states that the child is a female.
38. 1. The terms are not used interchangeably.
Inguinal hernia refers to protrusion of
abdominal tissue into the groin, and a
hydrocele refers to a fluid-filled mass in
the scrotum.
2. The symptoms are similar, but an
inguinal hernia occurs when tissue protrudes into the groin, and a hydrocele
is a fluid-filled mass in the scrotum.
3. A hydrocele does not occur in females.
4. A hydrocele is not associated with an
increased risk of malignancy.
TEST-TAKING HINT: This question depends
on knowledge of the definitions of inguinal
hernia and hydrocele.
39. 1. Surgery is usually done at an early age to
avoid incarceration, in which the hernia
causes impaired circulation to the
surrounding tissue.
2. The hernia tends to look larger when the
child strains or has a bowel movement.
3. The surgery is usually done on an
outpatient basis, and narcotics are not
usually needed.
4. The hernia often appears smaller
when the child is asleep.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because there are risks
associated with waiting for the repair, and
surgery is not done solely for cosmetic
reasons.
40. 1. Signs of an incarcerated hernia include
an acute onset of pain, abdominal
distention, and a mass that cannot be
reduced. Other signs are bloody
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stools, edema of the scrotum, and a
history of poor feeding.
2. The pain is not gradual but is acute in
onset.
3. The mass is not easily reduced.
4. The mass is not easily reduced, and the
child experiences acute, not gradual, onset
of pain.
TEST-TAKING HINT: The test taker can
eliminate answers 2 and 4 because the
onset of pain is not gradual.
41. 1. Wilms tumor grows very rapidly and
doubles in size in fewer than 2 weeks.
2. This response places blame on the parent.
Wilms tumor has a very good prognosis,
even when first diagnosed at a more
advanced stage.
3. This response is condescending and does
not acknowledge the parent as the person
who knows the child best.
4. The tumor is fast-growing and could
very easily not have been evident a few
days earlier.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because the nurse
should never cause the parent to feel guilt
and responsibility over any diagnosis.
42. 1. The blood pressure may be increased if
there is renal damage. The mass will be
located on one side or the other of the
midline of the abdomen. There is no reason
for the child’s temperature to be affected.
2. The blood pressure may be increased if
there is renal damage. The mass will be
located on one side or the other of the
midline of the abdomen. There is no
reason for the child’s temperature to be
affected.
3. The blood pressure may be increased
if there is renal damage. The mass will
be located on one side or the other of
the midline of the abdomen. There is
no reason for the child’s temperature
to be affected.
4. The blood pressure may be increased if
there is renal damage. The mass is located
on one side or the other of the midline of
the abdomen. There is no reason for the
child’s temperature to be affected.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 2 because the
mass is felt in the abdomen, not the back.
43. 1. When the nurse is unsure of the answer,
it is best to check and get back to the parents. The nurse should be aware that tests
of other organs are often performed to
evaluate for the presence of metastases.
2. The test is ordered to check for metastasis
to the lungs.
3. The test is done to see if the disease
has spread to the lungs.
4. A chest x-ray, not a magnetic resonance
image, is ordered routinely to evaluate the
health of the lungs prior to surgery.
TEST-TAKING HINT: The test taker should
be led to answer 3 because further testing
evaluates metastasis to other organs.
44. 1. The tumor is confined to the abdomen
but has spread to the lymph nodes or
peritoneal area. The prognosis is still
very good.
2. The tumor is confined to the abdomen
but has spread to the lymph nodes or
peritoneal area. The prognosis is still
very good.
3. Stage III does not indicate that the tumor
has spread to three other organs.
4. The tumor has not spread to other organs
beyond the peritoneal area. This would
represent stage IV, but with aggressive
treatment the child would still have a
good prognosis.
TEST-TAKING HINT: The test taker should
be led to answer 2 because this represents
stage III.
45. 1. The treatment of a Wilms tumor
involves removal of the affected kidney.
2. Removal of the unaffected kidney is not
necessary and is not done.
3. The entire kidney is removed.
4. A biopsy of the tissue of the unaffected
kidney is not necessary and is not obtained.
TEST-TAKING HINT: The test taker should
eliminate answers 3 and 4 because the
entire kidney is removed, not only the mass.
46. 1. A large incision is used because the kidney
is not removed laparoscopically at this time.
2. There is a post-operative shift of fluids
and organs in the abdominal cavity,
leading to increased discomfort.
3. The increased pain is due to shifting of
fluid and organs.
4. The increased pain is due to shifting of
fluid and organs.
TEST-TAKING HINT: The test taker should
eliminate answer 1 because the kidney is
not removed laparoscopically.
47. 1. Both disease processes are characterized
by the kidney’s inability to excrete waste.
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CRF occurs gradually and is irreversible,
whereas ARF occurs suddenly and may be
reversible.
2. Children can experience CRF and ARF.
3. CRF is irreversible, and it tends to occur
gradually.
4. ARF is often reversible, whereas CRF
results in permanent deterioration of
kidney function.
TEST-TAKING HINT: The test taker should
eliminate answer 1 because the terms
acute and chronic are not used interchangeably.
48. 1. CRF occurs gradually.
2. Examples of causes of prerenal failure
include dehydration and hemorrhage.
3. Primary kidney failure occurs when the
kidney experiences a direct injury. Examples include HUS and glomerulonephritis.
4. Postrenal failure occurs when there is an
obstruction to urinary flow. Hypotension
does not cause postrenal failure.
TEST-TAKING HINT: The test taker should
eliminate answer 1 because there is no
evidence of a chronic disease process.
49. 1. The patient is demonstrating signs of
hyperkalemia; therefore, intravenous
potassium would be contraindicated.
2. Sodium bicarbonate would be administered when metabolic acidosis is present.
3. Calcium gluconate is the drug of
choice for cardiac irritability secondary
to hyperkalemia.
4. The patient is demonstrating signs of
hyperkalemia; therefore, oral potassium
supplements would be contraindicated.
TEST-TAKING HINT: The test taker should
eliminate answers 1 and 4 because the
patient is already showing signs of
increased potassium levels.
50. 1. Sips of clear fluids and ice chips would
not replace the insensible losses. All
oral intake needs to be measured and
accurately recorded because “sips” can be
very subjective.
2. 350 mL is approximately a third of the
daily fluid requirement and is recommended for the child in the oliguric
phase of ARF. If the child were febrile,
the fluid intake would be increased.
3. 1000 mL represents the daily fluid
requirement in a healthy child.
4. 2000 mL is double the fluid requirement
of a healthy child and is contraindicated
in a child in the oliguric phase of ARF.
TEST-TAKING HINT: The question specifies
that the child is afebrile; therefore, the
test taker can eliminate answers 1 and 2
because extra fluid is not required.
51. 1. Although the child will likely receive
additional Kayexalate, the child’s condition
will likely not improve without dialysis.
2. Although the child will likely receive intravenous furosemide, the child’s condition
will likely not improve without dialysis.
3. Endotracheal intubation and ventilatory
assistance may be required, but ultimately
the child will need dialysis.
4. Placement of a Tenckhoff catheter for
peritoneal dialysis is needed when the
child’s condition deteriorates despite
medical treatment.
TEST-TAKING HINT: The test taker should
be led to answer 4 because dialysis is the
treatment required to reverse the existing
clinical manifestations.
52. 1. Hemodialysis is used in the pediatric
population.
2. Peritoneal dialysis has many complications,
such as peritonitis.
3. Peritoneal dialysis removes fluid at a
slower rate that is more easily controlled than that of hemodialysis.
4. Hemodialysis is much more efficient than
peritoneal dialysis.
TEST-TAKING HINT: The test taker should
eliminate answer 2 because very few
treatments are without complications.
53. 1. Cloudy returns and abdominal pain are
signs of peritonitis and are usually
treated with the administration of
antibiotics in the dialysis fluid.
2. Cloudy returns and abdominal pain are
signs of peritonitis and need to be treated.
3. Cloudy returns and abdominal pain are
signs of peritonitis and are usually treated
with the administration of antibiotics in
the dialysis fluid.
4. Cloudy returns and abdominal pain are
signs of peritonitis. In addition to
peritonitis, abdominal pain can be caused
by the rapid infusion of dialysis fluid.
TEST-TAKING HINT: The test taker can
eliminate answer 2 because pain would be
increased if the rate of administration
were increased.
54. 1. Increasing the concentration of glucose
will pull more fluid into the return.
2. Decreasing the concentration of glucose
will pull less fluid into the return.
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3. Antihypertensives and diuretics may be
administered, but changing the concentration of glucose in the dialysate will
help regulate the fluid balance.
4. Increasing the dwell time would help pull
more fluid into the return. Decreasing the
dwell time would pull less fluid into the
return.
TEST-TAKING HINT: The test taker should
eliminate answers 2 and 4 because they
decrease the amount of return.
55. 1. The child is experiencing signs of
disequilibrium syndrome, which is
caused by free water shifting from
intravascular spaces and can be prevented by slowing the rate of dialysis.
2. The patient’s temperature is not a causative
factor in disequilibrium syndrome.
3. Antibiotics are used to prevent peritonitis,
not disequilibrium syndrome.
4. The child’s weight should be obtained
immediately prior to dialysis.
TEST-TAKING HINT: The test taker should
eliminate answers 2 and 3 because they
are not associated with disequilibrium
syndrome.
56. 1. The retention of sodium and water
leads to hypertension.
2. The obstruction of the urinary system can
lead to renal failure but is not a direct
cause of hypertension.
3. The accumulation of waste products leads
to metabolic acidosis.
4. In CRF, the body experiences a state of
metabolic acidosis, not alkalosis.
TEST-TAKING HINT: The test taker should
eliminate answer 4 because metabolic
alkalosis is not associated with CRF.
57. 1. The kidneys are unable to excrete phosphorus, so phosphorus levels increase, and
calcium levels fall.
2. The calcium and phosphorus levels are
drawn from the bones in response to
low calcium levels.
3. The calcium is drawn from the bones in
response to low serum calcium levels.
4. Although the child may not be consuming
enough calcium, dietary deficiency is not
the primary cause of hypocalcemia.
TEST-TAKING HINT: The test taker should
eliminate answer 4 because dietary imbalances are not the primary cause of
hypocalcemia in renal failure.
58. 1. The child’s diet should be high in calories
and protein, but not all minerals and
electrolytes should be high. Sodium,
potassium, and phosphorus should be
restricted.
2. The child with CRF needs a diet high in
protein.
3. The child with CRF needs a diet high
in calories, protein, and calcium and
low in potassium and phosphorus.
4. Phosphorus should be restricted because
the kidneys are unable to excrete
phosphorus.
TEST-TAKING HINT: The test taker should
eliminate answer 2 because it is important
for the child to have a diet high in protein.
59. 1. The child is demonstrating signs of
rejection. Although pain control is always
important, antirejection medications are
of utmost importance.
2. Furosemide may be given to reduce
edema, but antirejection medications are
the most important for this child.
3. MiraLAX powder will help with constipation, but it will not help prevent rejection.
4. Corticosteroids are considered to be
part of the antirejection regimen that
is essential after a kidney transplant.
TEST-TAKING HINT: The test taker should
be led to answer 4 because it is the only
listed answer that is part of an antirejection regimen. Steroids can cause
irritability and weight gain.
60. 1. There are extensive post-transplant care
requirements.
2. This treatment option is not ideal for
families with a history of noncompliance
because there is extensive post-transplant
care associated with the receipt of a
kidney.
3. Renal transplantation frees the patient
from dialysis.
4. Renal transplantation is not new to the
pediatric population.
TEST-TAKING HINT: The test taker should
eliminate answer 1 because transplantation is a treatment, not a cure.
61. 1, 2, 3, 4.
1. Stressors such as the birth of a sibling
can lead to incontinence in a child who
previously had bladder control.
2. A pattern of enuresis can often be seen
in families.
3. Increased thirst and incontinence can
be associated with diabetes.
4. Irritability and incontinence can be
associated with UTIs.
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5. Preschool-age children do not habitually
share, so this information would not help
the nurse in gathering more information
on enuresis.
TEST-TAKING HINT: The test taker should be
able to eliminate answer 5 by knowing lack
of sharing is not unusual in preschoolers.
62. 2, 3.
1. It is referred to as a nephroblastoma, not
a neuroblastoma.
2. It can occur at any age but is seen
most often between the ages of
2 and 5 years.
3. It can occur on its own or can be
associated with many congenital
anomalies.
4. It is a tumor that grows very quickly.
5. It is associated with a very good prognosis.
TEST-TAKING HINT: The test taker would
have to know about Wilms tumor to
answer the question.
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Endocrine
Disorders
10
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Adrenal gland
Gonadotropin
Hyperthyroidism
Hypothyroidism
Myxedema
Pancreas
Pituitary gland
Type 1 diabetes (insulin-dependent
diabetes)
Type 2 diabetes (noninsulin-dependent
diabetes)
ABBREVIATIONS
Adrenocorticotropic hormone (ACTH)
Antidiuretic hormone (ADH)
Chronic renal failure (CRF)
Diabetes insipidus (DI)
Diabetes mellitus (DM)
Emergency department (ED)
Health-care provider (HCP)
Insulin-dependent diabetes mellitus
(IDDM)
Insulin-like growth factor-1 (IGF-1)
Insulin-like growth factor binding
protein-3 (IGFBP-3)
Noninsulin-dependent diabetes mellitus
(NIDDM)
Primary care provider (PCP)
Syndrome of inappropriate antidiuretic
hormone (SIADH)
Thyrocalcitonin (TC)
Thyroid hormone (TH)
Thyroid-stimulating hormone (TSH)
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QUESTIONS
1. At a follow-up visit for an 8-year-old who is being evaluated for short stature, the
nurse measures and plots the child’s height on the growth chart. Which explanation
should the nurse give the child and family?
1. “We want to make sure you were measured accurately the last two visits.”
2. “We need to calculate how tall you will be when you grow to adult height.”
3. “We need to see how much you have grown since your last visit.”
4. “We need to know your height so that a dosage of medication can be calculated
for you.”
2. What key information should be explained to the family of a 3-year-old who has short
stature and abnormal laboratory test results?
1. Due to the diurnal rhythm of the body, growth hormone levels are elevated following the onset of sleep.
2. Exercise can stimulate growth hormone secretion.
3. The initial screening tests need to be repeated for accuracy.
4. Growth hormone levels in children are so low that stimulation testing must be done.
3. A 6-year-old white girl comes with her mother for evaluation of her acne, breast buds,
axillary hair, and body odor. What information should the nurse explain to them?
1. This is a typical age for girls to go into puberty.
2. Encourage the girl to dress and act appropriately for her chronological age.
3. She should be on birth control as she is fertile.
4. She may be short if her epiphyses close early.
4. A nurse is caring for an infant who is very fussy and has a diagnosis of diabetes insipidus (DI). Which parameter should the nurse monitor while the infant is on fluid
restrictions?
1. Oral intake.
2. Urine output.
3. Appearance of the mucous membranes.
4. Pulse and temperature.
5. A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child?
1. Suggest weight loss.
2. Encourage attending school.
3. Emphasize that the disease will go into remission.
4. Encourage the child to take responsibility for daily medications.
6. The school nurse notices that a 14-year-old who used to be an excellent student and
very active in sports is losing weight and acting very nervous. The teen was recently
checked by the primary care provider (PCP), who noted the teen had a very low level
of TSH. The nurse recognizes that the teen has which condition?
1. Hashimoto thyroid disease.
2. Graves disease.
3. Hypothyroidism.
4. Juvenile autoimmune thyroiditis.
7. A newborn develops tetany and has a seizure prior to discharge from the nursery. The
newborn is diagnosed with hypocalcemia secondary to hypoparathyroidism and is
started on calcium and vitamin D. Which information would be most important for
the nurse to teach the parents?
1. They should observe the baby for signs of tetany and seizures.
2. They should observe for weakness, nausea, vomiting, and diarrhea.
3. They should administer the calcium and vitamin D daily as prescribed.
4. They should call the clinic if they have any questions about care of the newborn.
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8. A teen who was hospitalized for chronic renal failure (CRF) develops symptoms of
polyuria, polydipsia, and bone pain. Which body mineral might be causing these
symptoms?
1. Elevated calcium.
2. Low phosphorus.
3. Low magnesium.
4. High aluminum hydroxide.
9. The family of a young child has been told the child has diabetes insipidus (DI). What
information should the nurse emphasize to the family?
1. One caregiver needs to learn to give the injections of vasopressin.
2. Children should wear MedicAlert tags if they are over 5 years old.
3. Diabetes insipidus is different from diabetes mellitus.
4. Over time, the child may grow out of the need for medication.
10. A nurse is working with a child who has had a bone age evaluation. Which explanation of the test should the nurse give?
1. “The bone age will give you a diagnosis of your child’s short stature.”
2. “If the bone age is delayed, the child will continue to grow taller.”
3. “The x-ray of the bones is compared with that of the age-appropriate, standardized bone age.”
4. “If the bone age is not delayed, no further treatment is needed.”
11. Which descriptive terms should be used to describe a school-aged child with
myxedematous skin/eyes/hair changes?
1. The skin is oily and scaly.
2. The skin has pale, thickened patches.
3. The eyes are sunken, and the hair is thickened.
4. The eyes are puffy, the hair is sparse, and the skin is dry.
12. A child is brought to the ED with what is presumed to be acute adrenocortical insufficiency. Which of the following should the nurse do first?
1. Insert an IV line to administer fluids and cortisol.
2. Prepare for admission to the intensive care unit.
3. Indicate the likelihood of a slow recovery.
4. Discuss the likelihood of the child’s imminent death.
13. A child with Addison disease takes oral cortisol supplements and receives monthly
injections of desoxycorticosterone acetate injections. What teaching should be done
at each visit for the injections?
1. “Keep an extra month’s supply of all medications on hand at all times.”
2. “Wear a MedicAlert bracelet at all times.”
3. “The drug has a bitter taste.”
4. “Weight gain is inevitable.”
14. The nurse is instructing a family on the side effects of oral cortisone. What aspects
of administering the medication should the nurse emphasize?
1. Weight gain and dietary management.
2. Bitterness of the taste of the medication.
3. Excitability results from the medication.
4. Taking the medication with food to decrease gastric irritation.
15. An infant is born with ambiguous genitalia. Genetic testing and an ultrasound are ordered. The infant has a large clitoris, but there is no vaginal orifice. The labia appear
to be sac-like, darkened tissue. No testes are located. What suggestion should the
nurse offer the family?
1. Take the baby home, and wait until the gender is determined to name it.
2. Because the parents wanted a boy, give the baby a boy’s name.
3. Give the baby a neutral name that fits either a boy or a girl.
4. Call the infant baby until they know the gender.
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16. A baby has hypertension as a result of partial 21-hydroxylase deficiency. The parents
ask the nurse to clarify why the baby is being sent home on cortisone. Which is the
nurse’s best response about cortisone? It:
1. Increases the utilization of fatty acids for energy.
2. Depresses the secretion of ACTH.
3. Stimulates the adrenal glands.
4. Increases the response to inflammation.
17. A school-aged child is diagnosed with bilateral pheochromocytomas. Which clinical
manifestations should the nurse check for in this child?
1. Hypertension headache, and decreased gastrointestinal activity.
2. Hypoglycemia, lethargy, and increased gastrointestinal activity.
3. Bradycardia, diarrhea, and weight gain.
4. Hypotension, constipation, and anuria.
18. A teen comes into the clinic with complaints of having been under a lot of stress
recently. The teen is being treated for Addison disease and is taking cortisol and
aldosterone orally. Today, the teen shows symptoms of muscle weakness, fatigue, salt
craving, and dehydration. What should the nurse discuss with the teen regarding the
medications?
1. The dosages may need to be decreased in times of stress.
2. The dosages may need to be increased in times of stress.
3. The aldosterone should be stopped, and the cortisol should be increased.
4. The cortisol may need to be given IV to raise its level.
19. A 6-year-old is diagnosed with growth hormone deficiency. A prescription is written
for a dose of 0.025 mg/kg of somatotropin subcutaneously three times weekly. The
child weighs 59.4 lb. Which dose of medication should the nurse administer three
times weekly?
1. 0.5 mg.
2. 0.675 mg.
3. 1 mg.
4. 2 mg.
20. Somatotropin comes in a vial of 5 mg and is mixed with a diluent of 5 mL. There is
5 mL of solution in each vial. What amount of the solution should the nurse draw up
to give the appropriate dose each time?
1. 0.5 mL.
2. 0.675 mL.
3. 1 mL.
4. 2 mL.
21. A 7-year-old is diagnosed with central precocious puberty. The child is to receive a
monthly intramuscular (IM) injection of leuprolide acetate (Lupron). The child has
great fear of pain and needles and requires considerable stress reduction techniques
each time an injection is due. What could the nurse suggest that might help manage
the pain?
1. Apply a eutectic mixture of local anesthetics (EMLA) of lidocaine and prilocaine
to the site at least 60 minutes before the injection.
2. Have extra help on hand to help hold the child down.
3. Apply cold to the area prior to injection.
4. Identify a reward to bribe the child to behave during the injection.
22. A child weighs 21 kg. The parent asks for the weight in pounds. Which is the correct
equivalent?
1. 9.5 lb.
2. 46.2 lb oz.
3. 50 lb.
4. 60 lb.
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23. Parents bring their teen to the clinic with a tender, enlarged right breast. The nurse
explains that which hormone(s) secreted by the anterior pituitary influence(s) this
process? Select all that apply.
1. Thyrotropin.
2. Gonadotropin.
3. Oxytocin.
4. Somatotropin.
24. A toddler is admitted to the pediatric floor for hypopituitarism following removal of
a craniopharyngioma. The toddler has polyuria, polydipsia, and dehydration. Which
area of the brain was most affected by the surgery?
1. Posterior pituitary.
2. Anterior pituitary.
3. Autonomic nervous system.
4. Sympathetic nervous system.
25. Which hormone(s) does the anterior pituitary secrete? Select all that apply.
1. Thyroxine.
2. Luteinizing hormone.
3. Prolactin (luteotropic hormone).
4. ACTH.
5. Epinephrine.
6. Cortisol.
26. The adrenal cortex secretes sex hormones. Identify which hormones would result in
feminization of a young male child. Select all that apply.
1. Estrogen.
2. Testosterone.
3. Progesterone.
4. Cortisol.
5. Androgens.
27. Which test(s) could be utilized to determine cortisol levels in a child with suspected
Cushing syndrome? Select all that apply.
1. Fasting blood glucose.
2. Thyroid panel (TSH, T3, T4).
3. 24-hour urine for 17-hydroxycorticoids.
4. Radiographic studies of the bones.
5. Cortisone suppression test.
6. Urine culture.
7. Complete blood count.
28. A teen comes into the clinic with anxiety. Over the last 2 weeks, the teen has had
some muscle twitching and has a positive Chvostek sign. Which explanation could
the nurse provide to the parent about a Chvostek sign?
1. It is a facial muscle spasm elicited by tapping the facial nerve.
2. Muscle pain that occurs when touched.
3. The sign occurs because of increased intracranial pressure.
4. The sign is a result of a vitamin D overdose.
29. A school-aged girl is working on a school project on glands and asks the clinic
nurse to explain the function of the thymus gland. Which answer would the nurse
provide her?
1. It produces hormones that help with digestion.
2. It is a gland that disappears by the time a baby is born.
3. A major function is to stimulate the pituitary to act as the master gland.
4. The gland helps with immunity in fetal life and early childhood.
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30. A parent with a toddler who has ambiguous genitalia asks the nurse how long it will
be before the child identifies his or her gender. Which is the best answer?
1. “A child does not know his or her gender until he or she is a teen.”
2. “A child knows his or her gender by the age of 18 to 30 months.”
3. “A child knows from the time of birth what his or her gender is.”
4. “A child of 4 to 6 years is beginning to learn his or her gender.”
31. According to the growth chart below, an 8-kg boy who is 9 months old is in the
____________ percentile of weight-for-age?
32. The parent brings the growth record along with the 21-month-old child to a new
clinic for a well-child visit. The record shows a birth weight of 8 lb; the 6-month
weight was 16 lb; the 12-month weight was 18 lb; and the 15-month weight was
19 lb. With the record showing that the toddler’s weight-for-age has been decreasing, the nurse should do what initially?
1. Omit plotting the previous weight-for-age on the new growth chart.
2. Point out the growth chart to the new health-care provider (HCP).
3. Consider the toddler a child with failure to thrive.
4. Weigh the child, and plot on a new growth chart.
33. The thyroid gland secretes two types of hormones, thyroid hormone (TH) and
thyrocalcitonin (TC). Mark TH or TC in the correct spaces below.
1. ____________ This hormone regulates the metabolic rate of all cells.
2. ____________ This hormone regulates body heat production.
3. ____________ This hormone affects milk production during lactation; it also
affects menstrual flow.
4. ____________ This hormone maintains calcium metabolism.
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5. ____________ This hormone affects appetite and the secretion of gastrointestinal substances.
6. ____________ This hormone increases gluconeogenesis and utilization
of glucose.
34. A child with adrenal insufficiency is sick with influenza. The parent calls the office
and wants to know what to do. What is the first thing the nurse should advise this
parent?
1. Withhold all medications, and bring the child to the office.
2. Encourage the child to drink water and juices.
3. Give the child a dose of hydrocortisone, and bring the child to the office.
4. Let the child rest; the child will be better in the morning.
35. A toddler is being evaluated for syndrome of inappropriate antidiuretic hormone
(SIADH). The nurse should observe the child for which symptoms? Select all that
apply.
1. Dehydration.
2. Fluid retention.
3. Hyponatremia.
4. Hypoglycemia.
5. Myxedema.
36. What should the parent of a child with diabetes insipidus (DI) be taught about
administering desmopressin acetate nasal spray? Select all that apply.
1. The use of the flexible nasal tube.
2. Nasal congestion causes this route to be ineffective.
3. The medication should be administered every 48 hours.
4. The medication should be administered every 8 to 12 hours.
5. Overmedication results in signs of SIADH.
6. Nasal sprays do not always work as well as injections.
37. A school-aged child comes in with a sore throat and fever. The child was recently
diagnosed with Graves disease and is taking propylthiouracil. What concerns should
the nurse have about this child?
1. The child must not be taking her medication.
2. The child may have leukopenia.
3. The child needs to start an antibiotic.
4. The child is not getting enough sleep.
38. An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first?
1. Administer glucagon intramuscularly.
2. Offer the child 8 oz of milk.
3. Administer rapid-acting insulin lispro (Humalog).
4. Offer the child 8 oz of water or calorie-free liquid.
39. The nurse is caring for a 10-year-old post parathyroidectomy. Discharge teaching
should include which of the following?
1. How to administer injectable growth hormone.
2. The importance of supplemental calcium in the diet.
3. The importance of increasing iodine in the diet.
4. How to administer subcutaneous insulin.
40. The nurse is teaching the family about caring for their 7-year-old, who has been
diagnosed with type 1 diabetes mellitus. What information should the nurse provide
about this condition?
1. Best managed through diet, exercise, and oral medication.
2. Can be prevented by proper nutrition and monitoring blood glucose levels.
3. Characterized mainly by insulin resistance.
4. Characterized mainly by insulin deficiency.
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41. The most appropriate nursing diagnosis for a child with type 1 diabetes mellitus is
which of the following?
1. Risk for infection related to reduced body defenses.
2. Impaired urinary elimination (enuresis).
3. Risk for injury related to medical treatment.
4. Anticipatory grieving.
42. The nurse caring for a patient with type 1 diabetes mellitus is teaching how to selfadminister insulin. Which is the proper injection technique?
1. Position the needle with the bevel facing downward before injection.
2. Spread the skin prior to intramuscular injection.
3. Aspirate for blood return prior to injection.
4. Elevate the subcutaneous tissue before injection.
43. The nurse is caring for a child who complains of constant hunger, constant thirst,
frequent urination, and recent weight loss without dieting. Which can the nurse
expect to be included in care for this child?
1. Limiting daily fluid intake.
2. Weight management consulting.
3. Strict intake and output monitoring.
4. Frequent blood glucose testing.
44. The nurse is obtaining the medical history of an 11-year-old diagnosed with hypopituitarism. An important question for the nurse to ask the parents is which of the
following?
1. “Is the child receiving vasopressin intramuscularly or subcutaneously?”
2. “What time of day do you administer growth hormone?”
3. “Does your child have any concerns about being taller than the peer group?”
4. “How often is your child testing blood glucose?”
45. Which is an important nursing intervention for a child with a diagnosis of
hyperthyroidism?
1. Encourage an increase in physical activity.
2. Do pre-operative teaching for thyroidectomy.
3. Promote opportunities for periods of rest.
4. Do dietary planning to increase caloric intake.
46. A 13-year-old with type 2 diabetes mellitus asks the nurse, “Why do I need to
have this hemoglobin A1c test?” The nurse’s response is based on which of the
following?
1. To determine how balanced the child’s diet has been.
2. To make sure the child is not anemic.
3. To determine how controlled the child’s blood sugar has been.
4. To make sure the child’s blood ketone level is normal.
47. The nurse caring for a 14-year-old girl with diabetes insipidus (DI) understands
which of the following about this disorder?
1. DI is treated on a short-term basis with hormone replacement therapy.
2. DI may cause anorexia if proper meal planning is not addressed.
3. DI is treated with vasopressin on a lifelong basis.
4. DI requires strict fluid limitation until it resolves.
48. A 7-year-old is tested for diabetes insipidus (DI). Twenty-four hours after his fluid
restriction has begun, the nurse notes that his urine continues to be clear and pale,
with a low specific gravity. Which is the most likely reason for this?
1. Twenty-four hours is too early to evaluate effects of fluid restriction.
2. The urine should be concentrated, and it is unlikely the child has DI.
3. The child may have been sneaking fluids and needs closer observation.
4. In DI, fluid restriction does not cause urine concentration.
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49. The nurse has completed discharge teaching for the family of a 10-year-old diagnosed with diabetes insipidus (DI). Which statement best demonstrates the family’s
correct understanding of DI?
1. “The disease was probably brought on by a bad diet and little exercise.”
2. “Diabetes seems to run in my family, and that may be why my child has it.”
3. “My child will need to check blood sugar several times a day.”
4. “My child will have to use the bathroom more often than other children.”
50. The nurse is interviewing the parent of a 9-year-old girl. The parent expresses concern because the daughter already has pubic hair and is starting to develop breasts.
Which statement would be most appropriate?
1. “Your daughter should get her period in approximately 6 months.”
2. “Your daughter is developing early and should be evaluated for precocious puberty.”
3. “Your daughter is experiencing body changes that are appropriate for her age.”
4. “Your daughter will need further testing to determine the underlying cause.”
51. The nurse is taking care of a 10-year-old diagnosed with Graves disease. Which
could the nurse expect this child to have recently had?
1. Weight gain, excessive thirst, and excessive hunger.
2. Weight loss, difficulty sleeping, and heat sensitivity.
3. Weight gain, lethargy, and goiter.
4. Weight loss, poor skin turgor, and constipation.
52. A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history
of vomiting. The nurse observes that the child’s breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first?
1. Offer the child 8 oz of clear non-caloric fluid.
2. Test the child’s urine for ketones.
3. Prepare the child for an IV infusion.
4. Offer the child 25 g of carbohydrates.
53. Which would the school nurse expect in a student who has an insulin-to-carbohydrate
ratio of 1:10?
1. The student administers 10 U of regular insulin for every gram of carbohydrate
consumed.
2. The student is trying to limit carbohydrate intake to 10 g per insulin dose.
3. The student administers 1 U of regular insulin for every 10 grams of carbohydrate
consumed.
4. The student plans to eat 10 g of carbohydrate for every dose of insulin.
54. Which is the reason a student takes metformin (Glucophage) three times a day?
1. Type 1 diabetes mellitus.
2. Diabetes insipidus.
3. Inflammatory bowel disease.
4. Type 2 diabetes mellitus.
55. Which is the most likely reason an adolescent with diabetes has problems with low
self-esteem?
1. Managing diabetes decreases independence.
2. Managing diabetes complicates perceived ability to “fit in.”
3. Obesity complicates perceived ability to “fit in.”
4. Hormonal changes are exacerbated by fluctuations in insulin levels.
56. The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus.
Which statement indicates the student’s understanding of the disease?
1. “It really does not matter what type of carbohydrate I eat as long as I take the
right amount of insulin.”
2. “I should probably have a snack right after gym class.”
3. “I need to cut back on my carbohydrate intake and increase my lean protein intake.”
4. “Losing weight will probably help me decrease my need for insulin.”
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57. The nurse is assigned to care for a newborn with goiter. The nurse’s primary concern
is which of the following?
1. Reassuring the parents that the condition is only temporary and will be treated
with medication.
2. Maintaining a patent airway and preparing for emergency ventilation.
3. Preparing the infant for surgery and initiating pre-operative teaching with the
parents.
4. Obtaining a detailed history, particularly of medications taken during the mother’s
pregnancy.
58. A 13-year-old is being seen for an annual physical examination. The child has lost
10 lb despite reports of excellent appetite. Appearance is normal, except for slightly
protruding eyeballs, and the parents report the child has had difficulty sleeping lately.
The nurse should do which of the following?
1. Prepare the family for a neurology consult.
2. Explain the need for an ophthalmology consult.
3. Discuss the plan for thyroid function tests.
4. Explain the plan for an 8-hour fasting blood glucose test.
59. A 12-year-old with hyperthyroidism is being treated with standard antithyroid drug
therapy. A parent calls the office stating that the child has a sore throat and fever.
Which is the nurse’s best response?
1. “Bring your child to the office or emergency room immediately.”
2. “Slight fever and sore throat are normal side effects of the medication.”
3. “Give your child the appropriate dose of ibuprofen, and call back if symptoms
worsen.”
4. “Give your child at least 8 oz of clear fluids, and call back if symptoms worsen.”
Answer the following three questions with reference to the following figure.
A
B
C
D
E
F
G
H
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60. Hypofunction of which endocrine gland might cause type 2 diabetes mellitus?
______________________
61. Hyperfunction of which endocrine gland might cause Cushing syndrome?
______________________
62. Exophthalmic goiter is caused by hyperfunction of which endocrine gland?
______________________
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Height velocity is important to determine,
not whether the measurement was incorrect
at a previous visit.
2. Expected adult height can be determined
using a formula that takes into account the
parents’ height and can be calculated at any
visit.
3. Height velocity is the most important
aspect of a growth evaluation and can
demonstrate deceleration in growth if it
is present.
4. The dose of growth hormone replacement
medication is based on weight.
TEST-TAKING HINT: The health-care provider
(HCP) is interested in height velocity over
time. The need for multiple measurements
ensures that there is measurable growth
delay.
2. 1. Growth hormone levels elevate during
sleep but cannot be used to determine a definitive diagnosis.
2. Exercise increases growth hormone secretion
but cannot be used for definitive diagnosis.
3. Screening tests assist in determining in
which direction further studies should
be done.
4. The need for additional testing requires
explanation. The abnormal IGF-1 and
insulin-like growth factor binding protein require a definitive diagnosis when
the levels are either abnormally high or
low. Very young children do not secrete
adequate levels of growth hormone to
measure accurately and thus require
challenge/stimulation testing.
TEST-TAKING HINT: The test taker should
know that definitive diagnosis requires
more specific testing.
3. 1. Although girls in the United States mature
earlier than in previous decades, the lowest
age at which puberty is considered normal
is 7 years for white girls and 6 years for
African American girls.
2. Dressing and acting appropriately for
her chronological age should be encouraged for the well-being of the child.
188
3. Although she is fertile if she is pubescent, it
is not developmentally necessary to consider the use of birth control at this time.
4. The estrogen that is produced during
puberty does assist in the closure of the
epiphyseal plates. With proper medication
management, however, the estrogen
will be suppressed, and she will continue
to grow.
TEST-TAKING HINT: White girls sometimes
enter puberty as early as 7 years of age.
This is rare, however, and the extent of
her pubertal development should prompt
concern.
4. 1. Although monitoring fluid intake is necessary, the child is on fluid restriction, and
the amount of intake will be prescribed.
2. It is crucial to monitor and record urine
output. The infant with DI has hyposecretion of ADH, and fluid restriction has
little effect on urine formation. This
infant is at risk for dehydration and for
fluid and electrolyte imbalances.
3. It is a basic part of assessing the infant with
fluid restriction to monitor skin turgor and
the appearance of the mucous membranes,
but they are not an absolute determination
of overall well-being.
4. It is a basic part of assessing the infant to
check pulse and temperature (the infant can
become very hyperthermic), but neither
would be an absolute indicator of well-being.
TEST-TAKING HINT: DI results from pituitary
dysfunction. The posterior pituitary targets
the renal tubules and acts on the distal and
collecting tubules to make them permeable
to water, thus increasing resorption and decreasing excretion of urine.
5. 1. Children with Graves disease have voracious appetites and lose weight.
2. Encouraging school and continuation of
typical activities is better in terms of longterm management. Gym class and afterschool sports should be restricted until the
child is euthyroid.
3. Graves disease may go into remission after
2 or 3 years; there are some children, however, for whom it does not.
4. Because the child is 12 years old, encouraging responsibility for health care
is important. The child still needs family
involvement and ongoing supervision
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but should not be completely dependent
on family for care.
TEST-TAKING HINT: The age of the patient is
the key to answering the question.
6. 1. Hashimoto thyroiditis is a term that refers
to hypothyroid disease. Laboratory tests
would reveal a high TSH level.
2. Graves disease is hyperthyroidism and
presents with low TSH levels, weight
loss, and excessive nervousness.
3. Hypothyroidism is accompanied by a high
TSH level.
4. Juvenile autoimmune thyroiditis is a term
referring to hypothyroid disease. Laboratory tests would reveal a high TSH level.
TEST-TAKING HINT: The clues to the answer
are the low TSH level and the child’s
symptoms.
7. 1. The baby has hypocalcemia and is being
treated for this condition by the team. This
should be reviewed with the family.
2. Vitamin D toxicity (weakness, nausea,
vomiting, and diarrhea) is a serious consequence of therapy and should be the
top priority in teaching.
3. Reminding the family to give the medication as prescribed is helpful and should be a
basic part of discharge care, but it is not the
most important information.
4. Giving the family the phone number for
calling the clinic is part of basic care for
discharge to home, but it is not the most
important information.
TEST-TAKING HINT: Going over the side
effects and risks of vitamin D treatment educates the family about what to watch for
when giving the new medications.
8. 1. The most common causes of secondary
hyperparathyroidism are chronic renal
disease and anomalies of the urinary
tract. Blood studies indicate very high
levels of calcium because the kidney is
unable to process it.
2. Renal impairment causes phosphorus levels
to become very high, and patients in renal
failure are often put on low-phosphorus diets to control the levels.
3. Magnesium levels are elevated in chronic
renal failure because magnesium is excreted
in the urine. Magnesium is not regulated by
the parathyroid gland.
4. Aluminum hydroxide keeps phosphorus
mobilized so that it can be excreted.
TEST-TAKING HINT: CRF is caused by the
kidney’s inability to process waste and
excess minerals. Review which substances
in excess cause which symptoms.
9. 1. Training two caretakers in the administration of the vasopressin reinforces the
importance of the need to give the medication and ensures that medication can
be given when the primary caretaker is
unable to administer it. For someone on
long-term injectable medication, two
people need to know how to administer it
for the above reason.
2. Children should wear MedicAlert tags as
soon as they are diagnosed.
3. Explaining that DI is different from
DM is crucial to the parents’ understanding of the management of the disease. DI is a rare condition that affects
the posterior pituitary gland, whereas
DM is a more common condition that
affects the pancreas.
4. Children with DI do not grow out of their
condition and will require close medical
management and medications for the rest
of their lives.
TEST-TAKING HINT: The term diabetes is associated with DM. As DI is an uncommon
condition that is treated differently, families may easily confuse it with the more
common condition DM.
10. 1. Bone age is a method of assessing skeletal
maturity and does not give a diagnosis.
2. The child with a delayed bone age may
continue to grow. In many children with a
delayed bone age, medication is required
to help them continue to grow.
3. The bone age is a method of evaluating the epiphyseal growth centers of
the bone using standardized, ageappropriate tables.
4. A bone age that is not delayed in a child of
short stature is more concerning than if
the growth were delayed. This means that
further testing and evaluation are needed
if the growth delay is to be reversed.
TEST-TAKING HINT: Explaining a bone age
film clarifies for the family why the test is
needed.
11. 1. Oily skin is not associated with a low
serum thyroxine level. It is more consistent with hyperthyroidism.
2. Pale, thickened patches of skin are not
associated with hypothyroidism.
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3. Sunken eyes and thickened hair are not associated with hypothyroidism, in which
the hair is more often thin.
4. Myxedema, associated with low serum
thyroxine and raised thyrotropin levels,
is characteristic of hypothyroid dysfunction and presents with swelling or
puffiness of the limbs and face, sparse
hair, and very dry skin. These signs
may be accompanied by slowness of
movements and mental dullness.
TEST-TAKING HINT: Describing various
assessments is integral to charting accurately. Myxedema is a term used to describe hypothyroid skin.
12. 1. Initially, in the ED the child will be
given an IV line, vital signs will be
taken frequently, and seizure precautions will be taken.
2. The child will be sent to the intensive care
unit after being stabilized.
3. When children start to recover from an
adrenocortical crisis, their progress is
often very rapid, within 24 hours.
4. The child will present with headache, nausea and vomiting, high fever, high blood
pressure, weakness, and abdominal pain.
With prompt diagnosis and the institution
of cortisol and fluids, a good recovery is
likely.
TEST-TAKING HINT: The question is asking
for the priority nursing intervention,
which is starting an IV and taking VS.
2. The patient will quickly figure out that the
medication tastes bitter and that the taste
needs to be masked.
3. Excitability is not a common side effect.
4. Cortisone should be taken with food to
decrease gastric irritation.
TEST-TAKING HINT: Administration of cortisone can cause serious gastric irritation.
The nurse should teach the family to anticipate this problem and ensure that the
medicine is taken with food.
15. 1. The baby should not be discharged from
the hospital without a name, and never
call the infant it.
2. The fact that the gender is not known is
difficult for families to accept, but the
gender should be determined before discharge.
3. Selecting a gender-neutral name enables the family and child to gradually
accept and adjust to the baby’s medical
condition and sex.
4. Calling the infant baby is akin to using the
word it.
TEST-TAKING HINT: The family needs to be
given some positive way to cope with the
fact that the infant’s gender is in question.
13. 1. Keeping an extra month’s supply of all
medications, along with a prefilled syringe of hydrocortisone, will enable the
family to treat an impending adrenal
crisis before it gets severe.
2. Wearing a MedicAlert bracelet is advantageous and can be periodically mentioned
to the family.
3. Children will know the medication has a
bitter taste if they are taking the medication.
4. Weight gain will occur over time, but with
good diet and adequate exercise this can
be controlled.
TEST-TAKING HINT: Steroids are essential
to life, so it is important to remind the
family to have extra medication on hand at
all times.
16. 1. Cortisone increases the mobilization and
utilization of fatty acids for energy, but it
does not influence the hypertension.
2. Cortisone suppresses the ACTH being
secreted by the pituitary. Because very
little, if any, cortisol is produced by the
adrenal glands, the ACTH acts to increase cardiac activity and constrict the
blood vessels, leading to hypertension.
3. The adrenal glands synthesize and secrete
cortisol.
4. Cortisone suppresses lymphocytes,
eosinophils, and basophils, resulting in
a decreased inflammatory and allergic
response.
TEST-TAKING HINT: Regulation of hormonal secretions is based on negative
feedback. The 21-hydroxylase deficiency
is causing the adrenal gland to secrete too
little cortisol. The pituitary is producing
excess ACTH, trying to increase the adrenal secretion of cortisol, and causing the
hypertension.
14. 1. Weight gain can and should be controllable with appropriate eating habits and
adequate exercise.
17. 1. A pheochromocytoma is a rare tumor
of the adrenal glands that secretes excess catecholamines, which are a group
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CHAPTER 10 ENDOCRINE DISORDERS
of amines secreted in the body that act
as neurotransmitters. Examples include
epinephrine, norepinephrine, and
dopamine. Hypertension, headache,
and decreased gastric motility are common with pheochromocytoma.
2. A pheochromocytoma is a rare tumor of
the adrenal glands that secretes excess
catecholamines such as epinephrine,
norepinephrine, and dopamine. Hypoglycemia and lethargy are not typical of
pheochromocytoma. The excess catecholamines cause decreased, gastric
motility.
3. A pheochromocytoma is a rare tumor of
the adrenal glands that secretes excess
catecholamines such as epinephrine, norepinephrine, and dopamine. Bradycardia,
diarrhea, and weight gain are not typical
of pheochromocytoma.
4. A pheochromocytoma is a rare tumor of
the adrenal glands that secretes excess
catecholamines such as epinephrine,
norepinephrine, and dopamine. These
excess catecholamines cause hypertension, not hypotension. Although they
can cause decreased gastrointestinal activity, anuria is not typical of pheochromocytoma.
TEST-TAKING HINT: The tumor arises from
the adrenal medulla. The adrenal medulla
secretes epinephrine and norepinephrine.
Symptoms are those of excess hormones
from the adrenal medulla.
18. 1. Addison disease is another term for chronic
adrenocortical insufficiency. Medications
that replace normal glucocorticoids need
to be increased, not decreased, in times of
stress.
2. Because the adrenal glands are not
producing enough glucocorticoids, the
dosage of both the cortisol and aldosterone must be increased and sometimes tripled in times of stress.
3. Addison disease is another term for chronic
adrenocortical insufficiency. Both medications need to be continued.
4. Addison disease is another term for chronic
adrenocortical insufficiency. Oral medications should be increased in times of
stress.
TEST-TAKING HINT: The adrenal gland is
not able to produce enough hormone,
especially during times of stress.
19. 1. First change the weight in pounds to kilograms by dividing the pounds by 2.2 =
27 kg. Determine the dosage of medication by multiplying 27 kg by the medication prescribed at 0.025 mg/kg. The total
dosage needed is 0.675 mg.
2. First change the weight in pounds to
kilograms by dividing the pounds by
2.2 = 27 kg. Determine the dosage of
medication by multiplying 27 kg by the
medication prescribed at 0.025 mg/kg.
The total dosage needed is 0.675 mg.
3. First change the weight in pounds to kilograms by dividing the pounds by 2.2 =
27 kg. Determine the dosage of medication by multiplying 27 kg by the medication prescribed at 0.025 mg/kg. The total
dosage needed is 0.675 mg.
4. First change the weight in pounds to kilograms by dividing the pounds by 2.2 =
27 kg. Determine the dosage of medication by multiplying 27 kg by the medication prescribed at 0.025 mg/kg. The total
dosage needed is 0.675 mg.
TEST-TAKING HINT: Multiplying the milligrams per kilogram of weight by the patient’s kilograms of weight yields the total
milligrams dosage ordered.
20. 1. Determine the amount of solution by
setting up an equation of 5 mg/5 mL as
0.675 mg/X mL = 0.0675 mL.
2. Determine the amount of solution by
setting up an equation of 5 mg/5 mL as
0.675 mg/X mL = 0.0675 mL.
3. Determine the amount of solution by
setting up an equation of 5 mg/5 mL as
0.675 mg/X mL =0 .0675mL.
4. Determine the amount of solution by
setting up an equation of 5 mg/5 mL as
0.675 mg/X mL = 0.0675mL.
TEST-TAKING HINT: The medication is
mixed as 1 mg per each mL. Give 0.675 mL
of the solution three times weekly.
21. 1. EMLA cream works well for skin and
cutaneous pain. Having the child assist
in putting on the EMLA patch involves the child in the pain-relieving
process.
2. Because this is a monthly injection, it
would not be appropriate to hold the child
down forcefully, as this creates greater fear
and anxiety.
3. Apply ice to the opposite side of the body.
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4. Bribing children teaches them that the
more they cry and fuss, the more they are
rewarded.
TEST-TAKING HINT: Developing a trusting
relationship with the child by allowing the
child to help apply the EMLA cream gives
the child some control in relieving the
pain.
22. 1. 2.2 lb = 1 kg. Multiplying the kilograms by
2.2 yields 46.2 lb.
2. 2.2 lb = 1 kg. Multiplying the kilograms
by 2.2 yields 46.2 lb.
3. 2.2 lb = 1 kg. Multiplying the kilograms by
2.2 yields 46.2 lb.
4. 2.2 lb = 1 kg. Multiplying the kilograms by
2.2 yields 46.2 lb.
TEST-TAKING HINT: Parents frequently ask
for “lay” terms of medical data. Knowing
that there are 2.2 pounds in each kilogram
enables determination of this number.
23. 1. Thyrotropin and somatotropin are secreted by the anterior pituitary but do not
directly influence breast development.
2. The gonadotropins stimulate the
gonads to mature and produce sex
hormones.
3. Oxytocin is secreted by the posterior pituitary but does target the uterus and production of milk from the breasts.
4. Thyrotropin and somatotropin are secreted by the anterior pituitary but do not
directly influence breast development.
TEST-TAKING HINT: The anterior pituitary
is responsible for stimulating and inhibiting the secretions from the various target
organs.
24. 1. The posterior pituitary is responsible
for the secretion of ADH and control
of the renal tubules. The symptoms are
those of DI.
2. The anterior pituitary functions as the
master gland for growth, sexual function,
and skin but does not directly influence
the urinary system.
3. The autonomic nervous system is not directly responsible for polyuria, polydipsia,
and dehydration.
4. The sympathetic nervous system is not directly responsible for polyuria, polydipsia,
and dehydration.
TEST-TAKING HINT: The symptoms are
classic for posterior pituitary dysfunction.
25. 1. Thyroxine is secreted by the thyroid
gland.
2. Luteinizing hormone, prolactin, and
ACTH are secreted by the anterior
pituitary.
3. Luteinizing hormone, prolactin, and
ACTH are secreted by the anterior
pituitary.
4. Luteinizing hormone, prolactin, and
ACTH are secreted by the anterior
pituitary.
5. Epinephrine is secreted by the adrenal
medulla.
6. Cortisol is secreted by the adrenal cortex.
TEST-TAKING HINT: The pituitary is the master gland and is responsible for stimulating
and inhibiting target glands. The thyroid
and the adrenal glands are target glands.
26. 1. Estrogen and progesterone are hormones secreted by the adrenal cortex
that in excess would cause feminization
of a young male child.
2. Testosterone is secreted by the testes and
does not result in feminization.
3. Estrogen and progesterone are hormones secreted by the adrenal cortex
that in excess would cause feminization.
4. Cortisol is a glucocorticoid that is secreted
by the adrenal cortex but does not result
in feminization.
5. Androgens are secreted by the adrenal
cortex but would cause masculinization of
the child.
TEST-TAKING HINT: The sex hormones influence the development of the reproductive
organs and secondary sexual characteristics.
Male feminization is a result of hypofunction of primarily the male sex hormones.
27. 1. A fasting blood glucose is helpful in determining the child’s overall health but does
not demonstrate excess cortisol production
by the body.
2. A thyroid panel is helpful in determining
the child’s overall health but does not
demonstrate excess cortisol production by
the body.
3. A 24-hour urine for 17-hydroxycorticoids or a cortisone suppression test is
used for diagnosing overproduction of
cortisol by the body.
4. Radiographic bone studies are helpful in
determining the child’s overall health but
do not demonstrate excess cortisol production by the body.
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5. A 24-hour urine for 17-hydroxycorticoids
or a cortisone suppression test is used for
diagnosing overproduction of cortisol by
the body.
6. A urine culture is helpful in determining
the child’s overall health but does not
demonstrate excess cortisol production by
the body.
7. A complete blood count is helpful in determining the child’s overall health but
does not demonstrate excess cortisol production by the body.
TEST-TAKING HINT: Cortisol levels can be
measured with urine-specific testing.
28. 1. Chvostek sign is a facial muscle spasm
elicited by tapping on the facial nerve
in the region of the parotid gland, indicates heightened neuromuscular activity, and leads the nurse to suspect
hypoparathyroidism.
2. Chvostek sign is a facial muscle spasm
elicited by tapping on the facial nerve
in the region of the parotid gland,
indicates heightened neuromuscular
activity, and leads the nurse to suspect
hypoparathyroidism.
3. Chvostek sign is a facial muscle spasm
elicited by tapping on the facial nerve
in the region of the parotid gland,
indicates heightened neuromuscular
activity, and leads the nurse to suspect
hypoparathyroidism.
4. Chvostek sign is a facial muscle spasm
elicited by tapping on the facial nerve
in the region of the parotid gland,
indicates heightened neuromuscular
activity, and leads the nurse to suspect
hypoparathyroidism.
TEST-TAKING HINT: If a facial muscle
spasm can be elicited, then the nurse
would strongly suspect the child has
hypothyroidism.
29. 1. The glands that line the gastrointestinal
tract contain cells that produce hormones
that control and coordinate secretion of
digestive enzymes.
2. The thymus gland is well developed in infancy, attains its greatest size at puberty,
and then is changed into fatty tissue.
3. The pituitary gland is the master gland for
the body.
4. The thymus acts to provide immunity
to the very young body.
TEST-TAKING HINT: The girl wants informa-
tion about the function of the thymus gland.
30. 1. Teens know their gender and may try on
the roles of the opposite gender.
2. Children 18 months to 30 months
learn their gender from examining and
touching their body parts and learning
roles that are either male or female.
3. Newborns do not identify with one gender
or the other.
4. By 4 to 6 years of age, children have a
clear understanding of their gender and
the male or female roles that they are
assigned.
TEST-TAKING HINT: Erikson’s stages of psychosexual development define a 2-year-old
as in the “autonomy vs. shame and doubt”
stage. The 2-year-old explores the body
and is given specific behaviors that indicate the gender.
31. 10th percentile. The child would be in the
10th percentile in comparison with other
boys the same age.
TEST-TAKING HINT: Mark the age of the
child on the horizontal axis and find the
weight in kilograms on the vertical axis;
the weight-for-age percentile is where the
two lines intersect.
32. 1. The data from the previous primary care
provider are important for comparison
purposes.
2. The provider should be made aware of
the decelerating weight for age. This
pictorial information can then be reviewed with the parent.
3. Failure to thrive is a diagnosis that can be
organic, nonorganic, or idiopathic. Labeling a patient as having failure to thrive
prior to the assessment is inappropriate.
4. Weighing toddlers can be a challenge, because they are very active. The new weight
should be obtained with only a diaper on
the child. It should be recorded along with
the previous provider’s weights.
TEST-TAKING HINT: The nurse helps the
health-care provider by identifying areas
of concern.
33. 1. TH; the main physiological effect of TH
is to regulate the basal metabolic rate and
thereby control the process of growth and
tissue differentiation.
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2. TH; the main physiological effect of TH
is to regulate the basal metabolic rate and
thereby control the process of growth
and tissue differentiation.
3. TC; the main effects that TC causes are
related to lactation and menstrual flow.
4. TC; the main effects that TC causes are
related to maintenance of blood calcium
levels by decreasing calcium concentration
in the blood.
5. TH; the main physiological effect of TH
is to regulate the basal metabolic rate and
thereby control the process of growth
and tissue differentiation.
6. TH; the main physiological effect of TH
is to regulate the basal metabolic rate and
thereby control the process of growth
and tissue differentiation.
TEST-TAKING HINT: TH is involved in many
activities, and TC functions primarily to
maintain calcium balance.
34. 1. The family should administer the reserve
hydrocortisone injection intramuscularly
immediately and then bring the child to
the office.
2. When children with adrenal insufficiency
get influenza or are ill, the situation can be
life threatening. The family should administer the reserve hydrocortisone injection
intramuscularly and then bring the child
to the office.
3. When children with adrenal insufficiency get influenza or are ill, the
situation can be life threatening. The
family should administer the reserve
hydrocortisone injection intramuscularly and then bring the child to the
office. There is no harm in giving
extra hydrocortisone.
4. When children with adrenal insufficiency
get influenza or are ill, the situation can be
life threatening.
TEST-TAKING HINT: Because this child cannot produce hydrocortisone, the levels fall
and cause abdominal pain, nausea, and
vomiting. The child needs additional cortisol to recover.
35. 1. Dehydration is not a feature of SIADH.
2. ADH assists the body in retaining fluids and subsequently decreases serum
osmolarity while the urine osmolarity
rises. When serum sodium levels are
decreased below 120 mEq/L, the child
becomes symptomatic.
3. ADH assists the body in retaining fluids and subsequently decreases serum
osmolarity while the urine osmolarity
rises. When serum sodium levels are
decreased below 120 mEq/L, the child
becomes symptomatic.
4. Hypoglycemia is not a feature of SIADH.
5. Myxedema is not a feature of SIADH.
TEST-TAKING HINT: The posterior pituitary
is responsible for secretion of ADH.
SIADH is oversecretion of ADH.
36. 1. Administering desmopressin acetate
per nasal spray is a means of providing
the necessary medication in a steady
state, if it is given using the flexible
nasal tube every 8 to 12 hours. This
decreases nasal irritation.
2. If the child becomes ill with rhinorrhea, the nasal spray will need to be
administered via the buccal mucosa or
rectum or the medication changed to
tablets.
3. Administering desmopressin acetate per
nasal spray is a means of providing the
necessary medication in a steady state, if it
is given using the flexible nasal tube every
8 to 12 hours.
4. Administering desmopressin acetate
per nasal spray is a means of providing
the necessary medication in a steady
state, if it is given using the flexible
nasal tube every 8 to 12 hours.
5. Side effects of the desmopressin acetate are those of SIADH.
6. Administering desmopressin acetate per
nasal spray is a means of providing the
necessary medication in a steady state, if it
is given using the flexible nasal tube every
8 to 12 hours.
TEST-TAKING HINT: Administering medication necessitates the parent be instructed
in the technique, side effects, and what to
do if the medication cannot be administered for some reason.
37. 1. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.
2. Propylthiouracil is used to suppress
thyroid function. One of the grave
complications of the medication is
leukopenia.
3. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.
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CHAPTER 10 ENDOCRINE DISORDERS
4. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.
TEST-TAKING HINT: Side effects of a medication need to be assessed quickly. During the first few weeks of therapy there is
a risk of blood dyscrasias. The propylthiouracil prevents the conversion of iodine to
its usable form.
38. 1. Glucagon is given only for severe hypoglycemia. The child’s symptoms are those
of mild hypoglycemia.
2. Milk is best to give for mild hypoglycemia, which would present with
the symptoms described.
3. Insulin is appropriate for elevated blood
glucose, but the symptoms listed are those
of hypoglycemia, not hyperglycemia. It is
important for the test taker to be able to
distinguish between the two.
4. Water is appropriate for mild hyperglycemia, but the symptoms listed are
those of hypoglycemia.
TEST-TAKING HINT: The test taker should
first determine hyper- or hypoglycemia,
which should permit elimination of two
choices, then choose the best answer.
When describing symptoms of a diabetic
patient, look for ways to determine either
hypoglycemia or hyperglycemia.
39. 1. Growth hormone would be appropriate if
the patient had panhypopituitarism.
2. The parathyroid is responsible for calcium reabsorption; therefore, supplemental calcium in the diet is the important point to be discussed in patient
teaching.
3. Iodine is another important dietary
supplement.
4. Information about insulin injection is
appropriate for diabetes mellitus, not
parathyroid disorder.
TEST-TAKING HINT: The test taker needs
to know the function of the parathyroid
glands.
40. 1. Type 2 DM is best managed by diet, exercise, and oral medication.
2. Proper diet and monitoring blood glucose
are important in type 1 DM but DM is
characterized by insulin deficiency.
3. Though insulin resistance can be one of
the factors in type 1 DM, it is not the
primary factor.
4. Individuals with type 1 DM do not produce insulin. If one does not produce
insulin, type 1 DM is the diagnosis.
TEST-TAKING HINT: The test taker should
know the difference between type 1 and
type 2 DM.
41. 1. Risk for infection is a correct nursing
diagnosis. Understanding DM is understanding the effect it has on peripheral circulation and impairment of defense mechanisms.
2. Although many children with type 1 DM
present with enuresis, impaired urinary
elimination is not the best response.
3. Treatment includes injections, but this is
not a risk for injury.
4. Type 1 DM, although lifelong, is not a
terminal illness and can be well managed,
so grieving is not an appropriate diagnosis.
TEST-TAKING HINT: The test taker needs to
understand diabetes mellitus to choose
correctly.
42. 1. Correct needle position is at a 45° to
90° angle.
2. Injection is subcutaneous, so tissue is not
spread, as it would be for intramuscular
injection.
3. Aspiration for blood is not recommended
for subcutaneous injections.
4. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only
given subcutaneously.
TEST-TAKING HINT: The test taker must
understand that insulin is only given subcutaneously. Answers 2 and 3 can be eliminated by knowing how to give an intramuscular injection.
43. 1. Limiting fluids is appropriate for a child
presenting with the symptoms of DI.
2. Weight loss without the other presenting
symptoms might be indicative of a need
for a weight/nutrition consult.
3. Strict intake and output monitoring is
included in the care of a child with DI.
4. Frequent blood glucose testing is included in the care of a child with type
1 DM. The symptoms described in the
question are characteristic of a child just
prior to the diagnosis of type 1 DM.
TEST-TAKING HINT: In a question that lists
symptoms, it is important to determine
the diagnosis. In this case, the test taker
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can anticipate type 1 DM and know that
frequent glucose monitoring is part of the
plan of care.
44. 1. Vasopressin is a medication used to treat the
uncontrolled diuresis associated with DI.
2. Growth hormone is used to treat a
child with hypopituitarism.
3. Hypopituitarism promotes short, not tall,
stature.
4. Although hypoglycemia might be a factor
when a child is undergoing diagnostic testing for hypopituitarism, blood sugar testing is not part of the treatment plan.
TEST-TAKING HINT: When presented with a
question like this, the test taker must first
consider the diagnosis and the clinical
manifestations. Knowing that this diagnosis
is considered primarily when a child presents with short stature and slowed growth
curve, answer 2 is most appropriate.
45. 1. A child with hyperthyroidism displays increased activity.
2. Thyroidectomy is not the first choice for
treating hyperthyroidism, although it is
considered if other treatments fail.
3. Because increased activity is characteristic of hyperthyroidism, providing opportunity for rest is a recommended
nursing intervention.
4. Weight loss despite increased appetite and
intake might be a symptom of hyperthyroidism. Just increasing calories is not the
best option because the cause and treatment of the thyroid’s hyperactivity needs
to be addressed.
TEST-TAKING HINT: The test taker needs to
know the signs and symptoms of hyperthyroidism to determine appropriate nursing interventions.
46. 1. Balanced diet, although important, is not
determined by hemoglobin A1c.
2. Anemia would be a correct choice if the
question asked about hemoglobin, not
hemoglobin A1c.
3. Hemoglobin A1c, or glycosylated hemoglobin, reflects average blood glucose levels over 2 to 3 months. Frequent high blood glucose levels would
result in a higher hemoglobin A1c,
suggesting that blood glucose needs to
be in better control.
4. Presence of ketones in the blood, although
associated with the absence of insulin and
with high blood glucose levels, is not directly correlated with hemoglobin A1c.
TEST-TAKING HINT: The test taker needs
to know the purpose of the hemoglobin
A1c test.
47. 1. DI is caused by undersecretion of ADH
(vasopressin). Replacement therapy with
vasopressin is a long-term option, however, not a short-term one.
2. DI is not to be confused with DM, for
which dietary planning is a large part of
management.
3. Vasopressin is the treatment of choice. It
is important for patients and parents to
understand that DI is a lifelong disease.
4. Although a sign of DI is excessive urination, fluid replacement is needed, not restriction. Fluid restriction is only part of
the diagnostic phase.
TEST-TAKING HINT: The test taker needs to
understand the long-term implications of
the diagnosis.
48. 1. Within 24 hours of fluid restriction, the
urine becomes concentrated in a healthy
child.
2. Because the urine is not concentrated, the
child is likely to have DI.
3. Children should be carefully observed to
make sure they are not sneaking fluids;
however, the assumption that this child
has been doing so should not be made.
4. Children with DI cannot concentrate
urine.
TEST-TAKING HINT: Understanding that
DI causes uncontrolled diuresis, the test
taker should choose answer 4. Answers
1 and 3 assume that there is something
wrong with the diagnostic procedure and
would be less likely to be correct. Answer
2 is the opposite of answer 4.
49. 1. The primary causes of DI are idiopathic,
organic, and brain trauma, unlike the
causes for type 2 DM, for which diet and
exercise are major factors.
2. DI does not have a hereditary factor.
3. Blood sugar monitoring is important with
DM, not DI.
4. Despite the use of vasopressin to treat
the symptoms of DI, breakthrough urination is likely.
TEST-TAKING HINT: The test taker needs
to understand the difference between DI
and DM.
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50. 1. Menarche usually occurs within 2 years
after the start of breast development.
2. Age 9 is the average age of thelarche (breast
bud development), which is followed
shortly by the appearance of pubic hair.
3. The changes described in the question
are normal for a healthy 9-year-old
female.
4. No further testing is required.
TEST-TAKING HINT: Understanding that the
question describes a set of normal changes,
the test taker could eliminate answers 2
and 4. Because the parent in the question
is expressing concern, the most appropriate
answer from the remaining two is the one
offering reassurance, answer 3.
51. 1. Graves disease is a type of hyperthyroidism. Gradual weight loss, not weight
gain, is a sign.
2. Weight loss, increased activity, and
heat intolerance can be expected when
the thyroid gland is hyperfunctional.
3. Weight gain as a symptom makes this
answer incorrect.
4. Constipation and dry skin with poor
turgor are more likely in a patient with
hypothyroidism.
TEST-TAKING HINT: The test taker needs to
know the presenting signs and symptoms
of Graves disease.
52. 1. The fruity odor is that of acetone. The patient is exhibiting signs of ketoacidosis.
The history of vomiting and the Kussmaul
breathing preclude oral rehydration.
2. Although it is likely that ketones would be
present, the child is in a life-threatening
situation. Checking urine is not necessary.
3. This patient needs fluid and electrolyte
therapy to restore tissue perfusion
prior to beginning IV insulin therapy.
4. The patient is hyperglycemic, not hypoglycemic.
TEST-TAKING HINT: The patient’s history
of vomiting should clue the test taker to
disregard choices for food or fluids by
mouth, answers 1 and 4. Answer 2 might
be possible, as the urine would test positive for ketones, but the deep and rapid
breathing should help the test taker
choose answer 3.
53. 1. An insulin-to-carbohydrate ratio refers
to the amount of insulin given per gram
of carbohydrate. A ratio of 1:10 means
1 U regular insulin for every 10 g carbohydrates. This dose would be appropriate
if the child were planning a meal of 100 g
of carbohydrates.
2. Limiting carbohydrate intake is not a factor in managing type 1 DM.
3. An insulin-to-carbohydrate ratio refers
to the amount of insulin given per
gram of carbohydrate. A ratio of 1:10
means 1 U regular insulin for every
10 g carbohydrates.
4. An insulin-to-carbohydrate ratio refers to
the amount of insulin given per gram of
carbohydrate. A ratio of 1:10 means 1 U
regular insulin for every 10 g carbohydrates.
TEST-TAKING HINT: The test taker needs to
understand the insulin-to-carbohydrate
ratio.
54. 1. Type 1 DM is managed with insulin, not
oral agents.
2. DDAVP, not metformin, is used to treat
diabetes insipidus.
3. Methylprednisolone (Medrol) can be used
to treat inflammatory bowel disease.
4. Metformin is commonly used to manage type 2 DM.
TEST-TAKING HINT: Even being unfamiliar
with the name metformin, the test taker
might guess that Glucophage would have
something to do with destruction or digestion of glucose, thereby being able to
correctly eliminate answers 2 and 3.
55. 1. Managing DM increases rather than decreases independence.
2. Because the desire to fit in is so strong
in adolescence, the need to manage
one’s diabetes can compromise the
patient’s perception of ability to do so.
For example, an adolescent with type 1
DM has to plan meals and snacks, test
blood sugar, limit choices of when and
what to eat, and always be concerned
with the immediate health consequences of actions as simple as eating.
The fact that these limitations can negatively affect self-esteem is an essential
concept for the nurse caring for adolescents with diabetes to understand.
3. Obesity is not necessarily associated with
type 1 DM.
4. Hormone changes in adolescence often result in increasing insulin demands; however, increased insulin need not correlate
with low self-esteem.
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TEST-TAKING HINT: The test taker needs to
understand normal development in the
adolescent and that fitting in is extremely
important.
56. 1. A carbohydrate is a carbohydrate, and
insulin dosing is based on blood sugar
level and carbohydrates to be eaten.
2. Snacks should be ingested before planned
exercise rather than after.
3. Nutritional needs of children with DM do
not differ from those without DM.
4. Weight loss is likely a factor in managing
type 2 DM; type 1 DM is often preceded
by dramatic weight loss. The nutritional
needs of children with type 1 DM are essentially the same as those not affected.
TEST-TAKING HINT: The test taker needs
to understand the basics of DM and how
it is managed. Insulin and carbohydrates
have to complement each other for good
control.
57. 1. Goiter in a newborn can be life threatening and is usually treated by surgical removal or partial removal of the thyroid.
2. Goiter in a newborn can cause tracheal
compression, and positioning to help
relieve pressure (i.e., neck hyperextension) is essential. Emergency precautions for ventilation and possible tracheostomy are also instituted.
3. Although preparation for surgery might be
necessary, the most important intervention
is protecting the infant’s airway.
4. Certain medications (antithyroid drugs)
taken by the mother could predispose the
infant to developing a goiter. Although the
history is important, it is not the first priority for the nurse caring for this patient.
TEST-TAKING HINT: The test taker, if
unsure of the correct response, should
choose the one pertaining to the ABCs:
airway, breathing, and cardiac status.
58. 1. The patient exhibits signs of Graves disease, a primary type of hyperthyroidism in
children. A neurology consultation is not
indicated.
2. Despite the exophthalmos, an eye consultation is not indicated.
3. Diagnostic evaluation for hyperthyroidism is based on thyroid function
tests. It is expected in this case that T4
and T3 levels would be elevated, as the
thyroid gland is overfunctioning.
4. Fasting blood glucose is used to help evaluate for other endocrine disorders, such as
Cushing syndrome and DM.
TEST-TAKING HINT: One of the first nursing
considerations is identifying children with
hyperthyroidism.
59. 1. A complication of antithyroid drug
therapy is leukopenia. Fever and sore
throat, therefore, need to be evaluated
immediately. This is an essential component of discharge teaching for patients with Graves disease.
2. Because of the above explanation, this response is not appropriate.
3. This is a tempting choice for the test
taker, as fever and sore throat appear to be
fairly benign symptoms. Because the question includes information regarding
Graves disease and medication therapy,
however, the test taker should eliminate
this answer.
4. It is most likely that medication, not fluid
status, contributes to the child’s symptoms.
TEST-TAKING HINT: The test taker needs to
be familiar with adverse effects of all medications administered or that the family is
taught about.
60. F (pancreas)
TEST-TAKING HINT: Type 2 DM can be
caused by a slowed response of the
pancreas.
61. E (adrenal)
TEST-TAKING HINT: Cushing syndrome results from too much circulating cortisol.
62. C (thyroid)
TEST-TAKING HINT: Hyperfunction of the
thyroid may result in exophthalmic goiter.
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11
Neuromuscular or
Muscular Disorders
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Atrophy
Congenital
Contracture
Dystrophy
ABBREVIATIONS
Cerebral palsy (CP)
Computerized tomography (CT) scan
Cranial nerve (CN)
Emergency department (ED)
Guillain-Barré syndrome (GBS)
Magnetic resonance imaging (MRI)
QUESTIONS
1. An adolescent presents with sudden-onset unilateral facial weakness with drooping of
one side of the mouth. The teen is unable to close the eye on the affected side, but has
no other symptoms and otherwise feels well. The nurse could summarize the condition by which of the following?
1. The prognosis is poor.
2. This may be a stroke.
3. It is a fifth CN palsy.
4. This is paralysis of the facial nerve.
2. The nurse is performing an admission assessment on a 9-year-old who has just been
diagnosed with systemic lupus erythematosus. Which assessment findings should the
nurse expect?
1. Headaches and nausea.
2. Fever, malaise, and weight loss.
3. A papular rash covering the trunk and face.
4. Abdominal pain and dysuria.
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3. The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child’s disease. Which should the nurse tell them?
1. “Muscular dystrophies usually result in progressive weakness.”
2. “The weakness that your child is having will probably not increase.”
3. “Your child will be able to function normally and not need any special
accommodations.”
4. “The extent of weakness depends on doing daily physical therapy.”
4. The nurse should tell the parents of a child with Duchenne (pseudohypertrophic)
muscular dystrophy that some of the progressive complications include:
1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation.
2. Anorexia, gingival hyperplasia, and dry skin and hair.
3. Contractures, obesity, and pulmonary infections.
4. Trembling, frequent loss of consciousness, and slurred speech.
5. Which can elicit the Gower sign? Have the patient:
1. Close the eyes and touch the nose with alternating index fingers.
2. Hop on one foot and then the other.
3. Bend from the waist to touch the toes.
4. Walk like a duck and rise from a squatting position.
6. A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy.
Which nursing intervention would be appropriate?
1. Discuss with the parents the potential need for respiratory support.
2. Explain that this disease is easily treated with medication.
3. Suggest exercises that will limit the use of muscles and prevent fatigue.
4. Assist the parents in finding a nursing facility for future care.
7. Which foods would be best for a child with Duchenne muscular dystrophy?
1. High-carbohydrate, high-protein foods.
2. No special food combinations.
3. Extra protein to help strengthen muscles.
4. Low-calorie foods to prevent weight gain.
8. Which will help a school-aged child with muscular dystrophy stay active longer?
1. Normal activities, such as swimming.
2. Using a treadmill every day.
3. Several periods of rest every day.
4. Using a wheelchair upon getting tired.
9. The mother of a child with Duchenne muscular dystrophy asks the nurse who in the
family should have genetic screening. Who should the nurse say must be tested?
Select all that apply.
1. Mother
2. Sister.
3. Brother.
4. Aunts and all female cousins.
5. Uncles and all male cousins.
10. The nurse knows that teaching was successful when a parent states which of the
following are early signs of muscular dystrophy?
1. Increased muscle strength.
2. Difficulty climbing stairs.
3. High fevers and tiredness.
4. Respiratory infections and obesity.
11. The nurse is caring for a school-aged child with Duchenne muscular dystrophy in
the elementary school. Which would be an appropriate nursing diagnosis?
1. Anticipatory grieving.
2. Anxiety reduction.
3. Increased pain.
4. Activity intolerance.
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12. The nurse knows that teaching has been successful when the parent of a child with
muscle weakness states that the diagnostic test for muscular dystrophy is which of the
following?
1. Electromyelogram.
2. Nerve conduction velocity.
3. Muscle biopsy.
4. Creatine kinase level.
13. Why does spinal cord injury without radiographic abnormality sometimes occur in
children?
1. Children can suffer momentary severe subluxation and trauma to the spinal cord.
2. The immature spinal column in children does not allow for quality films.
3. The hemorrhaging that occurs with injury obscures radiographic abnormalities.
4. Radiographic abnormalities are not evident because of incomplete ossification of
the vertebrae.
14. Which should a nurse in the ED be prepared for in a child with a possible spinal
cord injury?
1. Severe pain.
2. Elevated temperature.
3. Respiratory depression.
4. Increased intracranial pressure.
15. The nurse evaluates the teaching as successful when a parent states that which of the
following can cause autonomic dysreflexia?
1. Exposure to cold temperatures.
2. Distended bowel or bladder.
3. Bradycardia.
4. Headache.
16. When assessing the neurological status of an 8-month-old, the nurse should check
for which of the following?
1. Clarity of speech.
2. Interaction with staff.
3. Vision test.
4. Romberg test.
17. Which symptoms will a child suffering from complete spinal cord injury experience?
1. Loss of motor and sensory function below the level of the injury.
2. Loss of interest in normal activities.
3. Extreme pain below the level of the injury.
4. Loss of some function, with sparing of function below the level of the injury.
18. The nurse is planning care for a child with a T12 spinal cord injury. Which lifelong
complications should the child and family know about? Select all that apply.
1. Skin integrity.
2. Incontinence.
3. Loss of large and small motor activity.
4. Loss of voice.
5. Flaccid paralysis.
19. After spinal cord surgery, an adolescent suddenly complains of a severe headache.
Which should be the nurse’s first action?
1. Check the blood pressure.
2. Check for a full bladder.
3. Ask if pain is present somewhere else.
4. Ask if other symptoms are present.
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20. An adolescent with a T4 spinal cord injury suddenly becomes dangerously hypertensive and bradycardic. Which intervention is appropriate?
1. Call the neurosurgeon immediately, as this sounds like sudden intracranial
hypertension.
2. Check to be certain that the patient’s bladder is not distended.
3. Administer Hyperstat to treat the blood pressure.
4. Administer atropine for bradycardia.
21. Which priority item should be placed at the bedside of a newborn with
myelomeningocele?
1. A bottle of normal saline.
2. A rectal thermometer.
3. Extra blankets.
4. A blood pressure cuff.
22. The nurse is caring for an infant with myelomeningocele who is going to surgery
later today for closure of the sac. Which would be a priority nursing diagnosis before
surgery?
1. Alteration in parent-infant bonding.
2. Altered growth and development.
3. Risk of infection.
4. Risk for weight loss.
23. Which should the nurse include when teaching sexuality education to an adolescent
with a spinal cord injury?
1. “You can enjoy a healthy sex life and most likely conceive children.”
2. “You will never be able to conceive if you have no genital sensation.”
3. “Development of secondary sex characteristics is delayed.”
4. “A few females have regular menstrual periods after injury.”
24. A child with a repaired myelomeningocele is in the clinic for a regular examination.
The child has frequent constipation and has been crying at night because of pain in
the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the
nurse tell the parent?
1. Tethered cord is a post-surgical complication.
2. Tethered cord occurs during times of slow growth.
3. Release of the tethered cord will be necessary only once.
4. Offering laxatives and acetaminophen daily will help control these problems.
25. Which should be included in the plan of care for a newborn with a myelomeningocele who will have a surgical repair tomorrow?
1. Offer formula every 3 hours.
2. Turn the infant back to front every 2 hours.
3. Place a wet dressing on the sac.
4. Provide pain medication every 4 hours.
26. Which should the nurse do first when caring for an infant who just had a repair of a
myelomeningocele?
1. Weigh diapers for 24-hour urine output.
2. Measure head circumference.
3. Offer clear fluids.
4. Assess for infection.
27. Which should be the priority nursing diagnosis for a 12-hour-old newborn with a
myelomeningocele at L2?
1. Altered bowel elimination related to neurological deficits.
2. Potential for infection related to the physical defect.
3. Altered nutrition related to neurological deficit.
4. Disturbance in self-concept related to physical disability.
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28. Over the last week, an infant with a repaired myelomeningocele has had a highpitched cry and been irritable. Length, weight, and head circumference have been at
the 50th percentile. Today length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which
of the following?
1. Tell the parent this is normal for an infant with a repaired myelomeningocele.
2. Tell the parent this might mean the baby has increased intracranial pressure.
3. Suspect the baby’s intracranial pressure is low because of a leak.
4. Refer the baby to the neurologist for follow-up care.
29. Which should the nurse tell the parent of an infant with spina bifida?
1. “Bone growth will be more than that of babies who are not sick because your
baby will be less active.”
2. “Physical and occupational therapy will be helpful to stimulate the senses and
improve cognitive skills.”
3. “Nutritional needs for your infant will be calculated based on activity level.”
4. “Fine motor skills will be delayed because of the disability.”
30. A 3-month-old with spina bifida is admitted to the nurse’s unit. Which gross motor
skills should the nurse assess at this age?
1. Head control.
2. Pincer grasp.
3. Sitting alone.
4. Rolling over.
31. A 15-year-old with spina bifida is seen in the clinic for a well-child checkup. The teen
uses leg braces and crutches to ambulate. Which nursing diagnosis takes priority?
1. Potential for infection.
2. Alteration in mobility.
3. Alteration in elimination.
4. Potential body image disturbance.
32. A school-aged child is admitted to the unit pre-operatively for bladder reconstruction. The child is latex-sensitive. Which intervention should the nurse implement?
1. Post a sign on the door and chart that the child is latex-allergic.
2. Use powder-free latex gloves when giving care.
3. Keep personal items such as stuffed animals in a plastic bag to avoid latex
contamination.
4. Use a disposable plastic-covered blood pressure cuff that will stay in the child’s room.
33. Which should the nurse prepare the parents of an infant for following surgical repair
and closure of a myelomeningocele shortly after birth? The infant will:
1. Not need any long-term management and should be considered cured.
2. Not be at risk for urinary tract infections or movement problems.
3. Have continual drainage of cerebrospinal fluid, needing frequent dressing
changes.
4. Need lifelong management of urinary, orthopedic, and neurological problems.
34. A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which
would the nurse expect in an infant with hydrocephalus?
1. Low-pitched cry and depressed fontanel.
2. Low-pitched cry and bulging fontanel.
3. Bulging fontanel and downwardly rotated eyes.
4. Depressed fontanel and upwardly rotated eyes.
35. The nurse is developing a plan of care for a child recently diagnosed with cerebral
palsy (CP). Which should be the nurse’s priority goal?
1. Ensure the ingestion of sufficient calories for growth.
2. Decrease intracranial pressure.
3. Teach appropriate parenting strategies for a special-needs child.
4. Ensure that the child reaches full potential.
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36. The nurse evaluates teaching of parents of a child newly diagnosed with cerebral
palsy (CP) as successful when the parents state that CP is which of the following?
1. Inability to speak and uncontrolled drooling.
2. Involuntary movements of lower extremities only.
3. Involuntary movements of upper extremities only.
4. An increase in muscle tone and deep tendon reflexes.
37. The parent of a toddler newly diagnosed with cerebral palsy (CP) asks the nurse
what caused it. The nurse should answer with which of the following?
1. Most cases are caused by unknown prenatal factors.
2. It is commonly caused by perinatal factors.
3. The exact cause is not known.
4. The exact cause is known in every instance.
38. Which developmental milestone should the nurse be concerned about if a 10-month-old
could not do it?
1. Crawl.
2. Cruise.
3. Walk.
4. Have a pincer grasp.
39. The parent of an infant asks the nurse what to watch for to determine if the infant
has CP. Which is the nurse’s best response?
1. “If the infant cannot sit up without support before 8 months.”
2. “If the infant demonstrates tongue thrust before 4 months.”
3. “If the infant has poor head control after 2 months.”
4. “If the infant has clenched fists after 3 months.”
40. The parent of a young child with CP brings the child to the clinic for a checkup.
Which parent’s statement indicates an understanding of the child’s long-term needs?
1. “My child will need all my attention for the next 10 years.”
2. “Once in school, my child will catch up and be like the other children.”
3. “My child will grow up and need to learn to do things independently.”
4. “I’m the one who knows the most about my child and can do the most for my child.”
41. A child with spastic CP had an intrathecal dose of baclofen in the early afternoon.
What is the expected result 31/2 hours post dose that suggests the child would
benefit from a baclofen pump?
1. The ability to self-feed.
2. The ability to walk with little assistance.
3. Decreased spasticity.
4. Increased spasticity.
42. The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both
ways, sits with some support, pushes food out of the mouth, and pushes away when
held. The parent asks about the infant’s development. The nurse responds by saying
which of the following?
1. “Your child is developing normally.”
2. “Your child needs to see the primary care provider.”
3. “You need to help your child learn to sit unassisted.”
4. “Push the food back when your child pushes food out.”
43. A child is admitted to the pediatric unit with spastic CP. Which would the nurse
expect a child with spastic CP to demonstrate? Select all that apply.
1. Increased deep tendon reflexes.
2. Decreased muscle tone.
3. Scoliosis.
4. Contractures.
5. Scissoring.
6. Good control of posture.
7. Good fine motor skills.
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44. A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse’s assessment follows: awake, pale, thin child lying in bed, multiple
contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C),
P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis
is most important?
1. Potential for skin breakdown: lying in one position.
2. Alteration in nutrition: less than body requirements.
3. Potential for impaired social support: mother sole caretaker.
4. Alteration in elimination: diarrhea.
45. The parent of an infant with CP asks the nurse if the infant will be mentally retarded.
Which is the nurse’s best response?
1. “Children with CP have some amount of mental retardation.”
2. “Approximately 20% of children with CP have normal intelligence.”
3. “Many children with CP have normal intelligence.”
4. “Mental retardation is expected if motor and sensory deficits are severe.”
46. Parents bring their 2-month-old into the clinic with concerns that the baby seems
“floppy.” The parents say the baby seems to be working hard to breathe, eats very
slowly, and seems to fatigue quickly. The nurse assesses intercostal retractions,
although the baby is otherwise in no distress. They add there was a cousin whose
baby had similar symptoms. The nurse would be most concerned with what possible
complications?
1. Respiratory compromise.
2. Dehydration.
3. Need for emotional support for the family.
4. Feeding intolerance.
47. The mother of a newborn relates that this is her first child, the baby seems to sleep a
lot, and does not cry much. Which question would the nurse ask the mother?
1. “How many ounces of formula does your baby take at each feeding?”
2. “How many bowel movements does your baby have in a day?”
3. “How much sleep do you get every night?”
4. “How long does the baby stay awake at each feeding?”
48. The mother of an infant diagnosed with Werdnig-Hoffmann disease asks the nurse
what she could have done during her pregnancy to prevent this. The nurse explains
that the cause of Werdnig-Hoffmann is which of the following?
1. Unknown.
2. Restricted movement in utero.
3. Inherited as an autosomal-recessive trait.
4. Inherited as an autosomal-dominant trait.
49. The parents of a toddler diagnosed with Werdnig-Hoffmann disease ask the nurse
what they can feed their child that would be quality food. Which would be good
choices for the nurse to recommend?
1. A hot dog and chips.
2. Chicken and broccoli.
3. A banana and almonds.
4. A milkshake and a hamburger.
50. The parent of a child diagnosed with Werdnig-Hoffmann disease notes times of not
being able to hear the child breathing. Which should the nurse do first?
1. Check pulse oximetry on the child.
2. Count the child’s respirations.
3. Listen to the child’s lung sounds.
4. Ask the parent if the child coughs at night.
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51. A child presents with a history of having had an upper respiratory tract infection 2
weeks ago; complains of symmetrical lower extremity weakness, back pain, muscle
tenderness; and has absent deep tendon reflexes in the lower extremities. Which is
important regarding this condition?
1. The disease process is probably bacterial.
2. The recent upper respiratory infection is not important information.
3. This may be an acute inflammatory demyelinating neuropathy.
4. CN involvement is rare.
52. A child with GBS has had lots of oral fluids but has not urinated for 8 hours. Which
is the nurse’s first action?
1. Check the child’s serum blood-urea-nitrogen level.
2. Check the child’s complete blood count.
3. Catheterize the child in and out.
4. Run water in the bathroom to stimulate urination.
53. The nurse is planning care for a child who was recently admitted with GBS. Which
is a priority nursing diagnosis?
1. Risk for constipation related to immobility.
2. Chronic sorrow related to presence of chronic disability.
3. Impaired skin integrity related to infectious disease process.
4. Activity intolerance related to ineffective cardiac muscle function.
54. Which should the nurse expect as an intervention in a child in the recovery phase of
GBS?
1. Assess for respiratory compromise.
2. Assess for swallowing difficulties.
3. Evaluate neuropsychological functioning.
4. Begin an active physical therapy program.
55. A child has a provisional diagnosis of myasthenia gravis. Which should the nurse
expect in this child? Select all that apply.
1. Double vision.
2. Ptosis.
3. Fatigue.
4. Ascending paralysis.
5. Sensory disturbance.
56. The nurse judges teaching as successful when the parent of a child with myasthenia
gravis states which of the following?
1. “My child should play on the school’s basketball team.”
2. “My child should meditate every day.”
3. “My child should be allowed to do what other kids do.”
4. “My child should be watched carefully for signs of illness.”
57. Which is the best advice to offer the parent of a 6-month-old with Werdnig-Hoffman
disease on how to treat the infant’s constipation?
1. Offer extra water every day.
2. Add corn syrup to two bottles a day.
3. Give the infant a glycerine suppository today.
4. Let the infant go 3 days without a stool before intervening.
58. Which should the nurse do for a 6-year-old living in a rural area who is missing
school shots and who has sustained a puncture wound?
1. Administer DTaP vaccine
2. Start the child on an antibiotic.
3. Clean the wound with hydrogen peroxide.
4. Send the child to the emergency department.
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59. Which should the nurse expect in a 2-week-old with a brachial plexus injury? Select
all that apply.
1. History of a normal vaginal delivery.
2. Small infant.
3. Absent Moro reflex on one side.
4. No sensory loss.
5. Associated clavicle fracture.
60. After surviving a motor vehicle accident but enduring a spinal cord injury, an adolescent is unable to walk but can use his arms, has no bowel or bladder control, and has
no sensation below the nipple line. Referring to the following figure, identify the
vertebral/spinal cord area most likely injured.
C1
C2
C3
C4
C5
C6
C7
C8
T1
T2
T3
T4
Cervical
Brachial
T5
T6
T7
T8
Thoracic
T9
T10
T11
T12
L1
L2
L3
Lumbar
L4
L5
S1
S2
S3
S4
S5
CO1
1.
2.
3.
4.
5.
6.
Cervical, C1–C5.
Cervical, C5–C7.
Thoracic, T1–T4.
Thoracic, T5–T12.
Lumbar, L2–L5.
Sacral, S1–S5.
Sacral
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61. Causes of autonomic dysreflexia include which of the following? Select all that apply.
1. Decrease in blood pressure.
2. Abdominal distention.
3. Bladder distention.
4. Diarrhea.
5. Tight clothing.
6. Hypothermia.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Paralysis of the facial nerve (CN VII) generally resolves within 2 to 4 weeks and has a
good prognosis. Treatment is supportive.
2. It would be very unusual for a healthy adolescent to have a stroke. One would also
expect other symptoms.
3. CN V (the trigeminal nerve) innervates the
muscles of mastication.
4. This patient has Bell’s palsy, which is an
idiopathic mononeuritis of CN VII (the
facial nerve) that innervates the face and
muscles of expression.
TEST-TAKING HINT: The test taker must
know CNs and their actions.
2. 1. Neuropsychiatric symptoms include difficulty concentrating in school and emotional
instability.
2. Fever, malaise, and weight loss are common presenting signs.
3. A rash is common, but with lupus it is usually a “butterfly” rash across the bridge of
the nose. Maculopapular rashes are common but are usually on sun-exposed areas.
4. Lupus nephritis requires urine output monitoring and is usually asymptomatic.
TEST-TAKING HINT: The test taker must
know the presenting signs and symptoms
of systemic lupus erythematosus.
3. 1. Muscular dystrophies are progressive
degenerative disorders. The most common is Duchenne muscular dystrophy,
which is an X-linked recessive disorder.
2. The weakness is progressive.
3. The child will require assistance, and the
need for it will increase with time and age.
4. Daily therapy may be helpful in decreasing
contractures, although it will not deter the
disease progression.
TEST-TAKING HINT: The test taker should
know that muscular dystrophy is a progressive degenerative disorder.
4. 1. These symptoms are common with Down
syndrome.
2. Duchenne muscular dystrophy does not
produce these symptoms.
3. The major complications of muscular
dystrophy include contractures, disuse
atrophy, infections, obesity, respiratory
complications, and cardiopulmonary
problems.
4. These symptoms are evidence of a possible
head injury.
TEST-TAKING HINT: The test taker should be
able to identify signs and symptoms attributable to the loss of muscle function.
5. 1. This is the Romberg sign, which measures
balance.
2. This test measures balance and coordination.
3. This test measures flexibility.
4. Children with muscular dystrophy display
the Gower sign, which is great difficulty
rising and standing from a squatting position due to the lack of muscle strength.
TEST-TAKING HINT: By eliminating cerebellar activities, the test taker would know
that the Gower sign assists in measuring
leg strength.
6. 1. Muscles become weaker, including those
needed for respiration, and a decision
will need to be made about whether
respiratory support will be provided.
2. This is a progressive disease, which medications do not treat.
3. Physical therapy will be part of the treatment
plan, but respiratory support is a priority.
4. The parents need to decide eventually if
they will keep the child home or cared for
in a nursing facility, but that is not an immediate concern.
TEST-TAKING HINT: Pseudohypertrophic
muscular dystrophy is a progressive neuromuscular disease with no cure.
7. 1. As the child with muscular dystrophy becomes less active, diet becomes more important. Attention should be paid to quality
and quantity of food, so the child does not
gain too much weight.
2. Good-quality foods are important as the
child continues to grow.
3. Extra protein will not help the child recover
from this disease.
4. As the child becomes less ambulatory,
moving the child will become more of a
problem. It is not good for the child to
become overweight for several health reasons in addition to decreased ambulation.
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TEST-TAKING HINT: Nutrition is important
for every child; as the child becomes less
ambulatory, weight concerns arise.
8. 1. Children who are active are usually
able to postpone use of a wheelchair. It
is important to keep using muscles for
as long as possible, and aerobic activity
is good for a child.
2. Use of a treadmill is not fun for children
or adults, so keeping the child using the
treadmill might be an issue.
3. Any child with a chronic disease should be
kept as active as possible for as long as
possible.
4. The goal is to keep the child as active as
possible to postpone use of a wheelchair
for as long as possible.
TEST-TAKING HINT: Appropriate interventions for different kinds of chronically ill
children can be similar, so think about
what would be best for this child.
9. 1, 2, 4.
1. Genetic counseling is important in all
inherited diseases. Duchenne muscular
dystrophy is inherited as an X-linked
recessive trait, meaning the defect is
on the X chromosome. Women carry
the disease, and males are affected. All
female relatives should be tested.
2. Women carry the disease, and males
are affected. All female relatives should
be tested.
3. Women carry the disease, and males are affected. All female relatives should be tested.
4. Women carry the disease, and males
are affected. All female relatives should
be tested.
5. Women carry the disease, and males are affected. All female relatives should be tested.
TEST-TAKING HINT: Knowing that Duchenne
muscular dystrophy is inherited as an Xlinked trait excludes father, brother, uncle,
and male cousins as carriers.
10. 1. Muscles become enlarged from fatty infiltration, so they are not stronger.
2. Difficulty climbing stairs, running,
and riding a bicycle are frequently the
first symptoms of Duchenne muscular
dystrophy.
3. High fevers and tiredness are not early
signs of muscular dystrophy but could be
later signs as complications become more
common.
4. Respiratory infections and obesity are major complications as the disease progresses.
TEST-TAKING HINT: Early symptoms have
to do with decreased ability to perform
normal developmental tasks involving
muscle strength.
11. 1. This diagnosis would relate to the family
and not to the child.
2. This diagnosis would relate to the family
and not to the child.
3. The child does not have pain with the
muscular dystrophy process.
4. The child would not be able to keep up
with peers because of weakness, progressive loss of muscle fibers, and loss
of muscle strength.
TEST-TAKING HINT: Knowing that the child
has decreased strength helps to answer
the question.
12. 1. The electromyelogram is part of the diagnostic workup, but muscle biopsy results
classify muscle disorders.
2. Nerve conduction velocity is part of the
diagnostic workup, but muscle biopsy
results classify muscle disorders.
3. Muscle biopsy confirms the type of
myopathy that the patient has.
4. Creatine kinase is in muscle tissue and is
found in large amounts in muscular diseases.
TEST-TAKING HINT: Muscle biopsy is the
definitive test for myopathies.
13. 1. Spinal cord injury without radiographic
abnormality results from the spinal
cord sliding between the vertebrae and
then sliding back into place without
injury to the bony spine. It is thought
to be the result of an immature spinal
column that allows for reduction after
momentary subluxation.
2. On x-ray the spinal cord and body structure
appear normal. The edema of the cord and
resulting ischemia can cause neurological
dysfunction below the level of the injury.
3. Hemorrhaging that occurs with the injury
does not obscure radiographic findings.
4. The vertebrae are adequately ossified for
radiographic study to reveal abnormalities.
TEST-TAKING HINT: The test taker must
understand the physiology of spinal cord
injuries in children.
14. 1. Severe pain is unlikely, but the child may
have pain at the injury site.
2. An elevated temperature is not common in
a spinal cord injury. In fact, most trauma
patients are hypothermic in spite of high
ambient temperatures.
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3. A spinal cord injury can occur at any
level. The higher the level of the injury, the more likely the child is to
have respiratory insufficiency or failure. The nurse should be prepared to
support the child’s respiratory system.
4. Spinal cord injury with an open or closed
head injury does not cause an increase in
intracranial pressure.
TEST-TAKING HINT: The test taker must
know the signs of a spinal cord injury.
15. 1. Exposure to cold temperatures does
not trigger an episode of autonomic
dysreflexia.
2. Autonomic dysreflexia results from an
uncontrolled, paroxysmal, continuous
lower motor neuron reflex arc due to
stimulation of the sympathetic nervous
system. It is a response that typically
results from stimulation of sensory receptors such as a full bladder or bowel.
3. Symptoms of autonomic dysreflexia are
bradycardia, headache, and potentially
life-threatening hypertension.
4. Symptoms of autonomic dysreflexia are
bradycardia, headache, and potentially
life-threatening hypertension.
TEST-TAKING HINT: The test taker must
know what triggers autonomic dysreflexia
and what the symptoms are.
16. 1. The infant is preverbal, so assessing clarity
of speech is not age-appropriate or developmentally appropriate.
2. Assessment for alteration in developmentally expected behaviors, such as
stranger anxiety, is helpful. Interaction
with staff is not to be expected due to
stranger anxiety.
3. Vision testing is not the priority assessment.
4. An 8-month-old infant is not tested with
the Romberg test.
TEST-TAKING HINT: The test taker must
know what is appropriate infant
development.
17. 1. Children with complete spinal cord injury lose motor and sensory function
below the level of the injury as a result
of interruption of nerve pathways.
2. Although spinal cord–injured children
may suffer depression, it is not correct to
state that all of them lose interest in normal activities.
3. Pain is absent below the level of the injury
because of loss of sensory function.
OR
MUSCULAR DISORDERS
4. Sparing of function below the level of the
injury occurs only when there is partial
spinal cord injury.
TEST-TAKING HINT: A spinal cord injury
causes loss of motor and sensory function
below the level of the injury.
18. 1, 2.
1. Spinal cord–injury patients experience
many issues due to loss of innervation
below the level of the injury. Skin integrity and incontinence are issues
because of immobility and loss of pain
receptors below the level of the injury.
2. Skin integrity and incontinence are issues because of immobility and loss of
pain receptors below the level of the
injury.
3. Loss of motor activity is also a result of
loss of innervation below the level of the
injury.
4. Loss of voice is not a complication of T12
injury.
5. Flaccid paralysis occurs initially but changes
to spasticity during the rehabilitation stage.
TEST-TAKING HINT: The test taker must
know the long-term effects of spinal cord
injuries.
19. 1. The autonomic nervous system responds
with arteriolar vasospasm, which results in
an uncontrolled increase in blood pressure. The parasympathetic nervous system
(vagus nerve) sends a stimulus to the heart
resulting in bradycardia and vasodilation.
2. The sympathetic nervous system responds to a full bladder or bowel resulting from an uncontrolled, paroxysmal, continuous lower motor neuron
reflex arc. This response is usually
from stimulation of sensory receptors
(e.g., distended bladder or bowel).
Because the efferent pulse cannot pass
through the spinal cord, the vagus
nerve is not “turned off,” and profound
symptomatic bradycardia may occur.
3. Pain is not usually felt below the level of
the injury, and pain elsewhere does not
cause a severe headache.
4. In autonomic dysreflexia, the patient does
not experience other symptoms.
TEST-TAKING HINT: Autonomic dysreflexia
is usually caused by a full bladder or
bowel.
20. 1. Sudden hypertension and bradycardia are
symptoms of autonomic dysreflexia.
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2. Check to be certain that the bladder
is not distended, which would trigger
autonomic dysreflexia.
3. The first intervention is to assess the bladder for fullness before administering any
medication.
4. The first intervention is to assess the bladder for fullness before administering any
medication.
TEST-TAKING HINT: The test taker must
know which symptoms are suggestive of
autonomic dysreflexia.
21. 1. Before the surgical closure of the sac,
the infant is at risk for infection. A
sterile dressing is placed over the sac
to keep it moist and help prevent it
from tearing.
2. The infant’s temperature will be taken, but
prevention of infection is the priority.
3. Prevention of infection is the priority.
Once the temperature is taken, it can be
determined if extra blankets are needed.
4. Blood pressure is difficult to monitor in
the newborn period. Prevention of infection is the priority.
TEST-TAKING HINT: The test taker should
focus on the care and potential complications of an infant with spina bifida to
answer the question correctly.
22. 1. This is certainly a possibility, but in the
pre-operative period risk of infection is
the priority.
2. Altered growth and development may occur, but in the pre-operative period risk of
infection is the priority.
3. A normal saline dressing is placed over
the sac to prevent tearing, which would
allow the cerebrospinal fluid to escape
and microorganisms to enter and cause
an infection.
4. It is normal in the first 2 weeks of life to
lose up to 10% of birth weight. In fact, this
infant may lose more weight because of
surgery, but the priority is risk of infection.
TEST-TAKING HINT: The pre-operative priority is risk of infection, especially when
effort is necessary to keep a sterile saline
dressing on the sac.
23. 1. The reproductive system continues to
function properly after a spinal cord injury. Much sexual activity and response
occurs in the brain as well.
2. Conception does not depend on sensation
in the genitals.
3. Secondary sex characteristics develop
normally.
4. Females may have irregular periods after
the injury, but most return to their normal
cycles.
TEST-TAKING HINT: Spinal cord injuries
have little effect on reproduction.
24. 1. Tethered cord is caused by scar tissue
formation from the surgical repair of the
myelomeningocele and may affect bowel,
bladder, or lower extremity functioning.
2. Tethered cord occurs during growth spurts.
3. Often the release of the tether will again
become necessary.
4. Laxatives and acetaminophen are temporary remedies, and they treat only the
symptoms.
TEST-TAKING HINT: Tethering is caused by
scar tissue from any surgical intervention
and may recur as the child grows.
25. 1. A newborn may want formula every 2 to
4 hours but frequently is too sleepy to eat
on a schedule.
2. The infant should not be positioned on
the back before surgery because of the potential to rupture the sac.
3. Priority care for an infant with a
myelomeningocele is to protect the
sac. A wet dressing keeps it moist with
less chance of tearing.
4. Infants with myelomeningocele do not
have pain because of lack of nerve innervations below the level of the defect.
TEST-TAKING HINT: Realizing the defect is
on the back eliminates answer 2. Knowing
newborns are sleepy and do not eat on a
schedule eliminates answer 1.
26. 1. Weighing diapers for 24-hour urine output totals is important, but it is not the
first thing to do following surgery.
2. Hydrocephalus occurs in about 90% of
infants with myelomeningocele, so
measuring the head circumference daily
and watching for an increase are important. Accumulation of cerebrospinal
fluid can occur after closure of the sac.
3. Clear fluids are offered after the infant is
fully awake and there is no vomiting.
4. Assessing for infection is important, but
infection is not usually seen in the initial
post-operative period.
TEST-TAKING HINT: The dynamics of the
cerebrospinal fluid change after closure of
the sac.
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27. 1. Infants with myelomeningocele have
altered bowel elimination as a result of
their defect, but this is not the priority.
2. Because this infant has not had a repair,
the sac is exposed. It could rupture,
allowing organisms to enter the cerebrospinal fluid, so this is the priority.
3. These infants usually eat normally.
4. The infant is too young to have a selfconcept disturbance yet.
TEST-TAKING HINT: Before surgery, the
myelomeningocele is exposed, so risk of
infection is much higher.
28. 1. The fact that the head circumference has
changed so much might indicate increased
intracranial pressure.
2. The increase in head size is one of the
first signs of increased intracranial
pressure; other signs include highpitched cry and irritability.
3. The increase in head size is one of the
first signs of increased intracranial pressure; other signs include high-pitched cry
and irritability.
4. This infant should be referred to the neurosurgeon, not the neurologist, and a CT
scan should be obtained to determine the
cause of the increase.
TEST-TAKING HINT: The test taker should
know how fast an infant’s head size changes.
29. 1. Bone growth is related to weight bearing
as well as to secretion of the growth hormone. Decreased activity usually results in
less bone growth.
2. Children with decreased activity due to
illness or trauma are helped by physical
and occupational therapy. The varied
activities stimulate the senses.
3. This is partially true. Nutritional needs in
children are also calculated based on
growth needs.
4. Many children with myelomeningocele
have low-level defects, usually in the lumbar area, which do not affect upper body
fine motor skills.
TEST-TAKING HINT: The test taker should
know normal growth patterns.
A 3-month-old has good head control.
Pincer grasp occurs at about 9 months.
Sitting alone occurs at about 6 months.
Rolling over occurs at about 4 months.
TEST-TAKING HINT: The test taker must
know normal developmental milestones.
30. 1.
2.
3.
4.
OR
MUSCULAR DISORDERS
31. 1. This is certainly a possibility, especially as
the teen uses braces and can have some
skin irritation.
2. This is a nursing diagnosis to attend to now,
because the teen uses braces and crutches.
3. Because the teen is ambulatory, the teen
probably has a lower-level defect, but even
lower-level defects have some type of
elimination issues.
4. As an adolescent on crutches and wearing braces, the teen would have the
issue of body image disturbance, which
must be addressed. This is a priority.
TEST-TAKING HINT: The test taker must
know normal development.
32. 1. Posting a sign on the door and charting
that the child has a latex allergy is important so others will be aware of the
allergy.
2. Do not use latex gloves with a child who
has a latex allergy.
3. Keeping personal items in a plastic bag
does not keep latex away from the child.
4. A plastic cover for the blood pressure cuff
is proper to use but is not related to the
latex allergy.
TEST-TAKING HINT: The test taker must
know which supplies have latex and about
contact allergies.
33. 1. Children with myelomeningocele have ongoing, lifelong, complex health-care needs.
2. Children with myelomeningocele may
have frequent urinary tract infections and
mobility concerns.
3. The surgical closure prevents the leakage
of cerebrospinal fluid; dressing changes are
necessary only during the post-operative
period.
4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require
lifelong management of neurological,
orthopedic, and elimination problems.
TEST-TAKING HINT: The test taker can
eliminate answer 1 due to the complexity
of myelomeningocele.
34. 1. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The
anterior fontanel bulges because of an
increase in cerebrospinal fluid, and an increase in intracranial pressure causes a
high-pitched cry in infants and downward
deviation of the eyes, also called sunset eyes.
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2. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The
anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a
high-pitched cry in infants and downward
deviation of the eyes, also called sunset eyes.
3. An alteration in the circulation of the
cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges
because of an increase in cerebrospinal
fluid, and an increase in intracranial
pressure causes a high-pitched cry in
infants and downward deviation of the
eyes, also called sunset eyes. With sunset eyes the sclera can be seen above
the iris.
4. An alteration in the circulation of the
cerebrospinal fluid causes hydrocephalus.
The anterior fontanel bulges because of
an increase in cerebrospinal fluid, and an
increase in intracranial pressure causes a
high-pitched cry in infants and downward deviation of the eyes, also called
sunset eyes.
TEST-TAKING HINT: The test taker must
know the difference in clinical signs of hydrocephalus in infants and older children.
Infants’ heads expand, whereas older
children’s skulls are fixed. The anterior
fontanel closes between 12 and 18 months.
35. 1. Adequate calories are an appropriate goal,
but the priority for a special-needs child is
that the child develop to full potential.
2. Children with CP do not have increased
intracranial pressure.
3. Teaching appropriate parenting strategies
for a special-needs child is important
and is done so the child can reach full
potential.
4. The priority for all children is to develop to their full potential.
TEST-TAKING HINT: All of these are important goals, but determining the priority
goal for a special-needs child is the key.
36. 1. Children may also have pseudobulbar involvement, which creates swallowing difficulties and recurrent aspiration.
2. Abnormal involuntary movements usually involve the face, neck, trunk, and
extremities.
3. Abnormal involuntary movements usually involve the face, neck, trunk, and
extremities.
4. The primary disorder is of muscle tone,
but there may be other neurological
disorders such as seizures, vision disturbances, and impaired intelligence.
Spastic CP is the most common type
and is characterized by a generalized
increase in muscle tone, increased deep
tendon reflexes, and rigidity of the
limbs on both flexion and extension.
TEST-TAKING HINT: The test taker must
know the definition of CP.
37. 1. At least 80% of cases of CP result from
unknown prenatal factors.
2. It used to be thought that CP resulted
from perinatal factors, but current
knowledge is that CP results more commonly from existing prenatal brain
abnormalities.
3. It used to be thought that CP resulted
from perinatal factors, but current knowledge is that CP results more commonly
from existing prenatal brain abnormalities.
4. Frequently, the exact cause is not known.
TEST-TAKING HINT: The test taker must
know the latest information to answer this
question correctly.
38. 1. Most infants are able to crawl unassisted by 8 months.
2. Infants learn to cruise (walk around
holding onto furniture) at about 9 to
10 months.
3. Walking occurs on average at about
12 months.
4. Pincer grasp (thumb and forefinger)
occurs at about 9 to 10 months.
TEST-TAKING HINT: The test taker must
know developmental milestones.
39. 1. Children with CP frequently have developmental delays, including not being able
to sit alone by 8 months. Sitting alone
usually occurs by 6 months, so 8 months
would be the outer limit of normal development and cause for concern.
2. Tongue thrust is common in infants
younger than 6 months, but if it goes on
after 6 months it is of concern.
3. Good head control is normally attained by
3 months.
4. Clenched fists after 3 months of age
may be a sign of CP.
TEST-TAKING HINT: The test taker must
know normal developmental milestones to
identify those that are abnormal.
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40. 1. The parent has an unrealistic picture of the
child’s future. The parent must help the child
achieve as much independence as possible in
order to achieve full potential.
2. The child probably will never catch up to
other children. That is part of the disorder, so the parent’s role is to help the child
achieve as much independence as possible.
3. This statement indicates that the parent understands the long-term needs
of the child.
4. Parents do know the most about their
children, but doing the most for the child
is not the best way to manage the child’s
development. The child must become as
independent as possible.
TEST-TAKING HINT: The test taker must
understand the goals for children with
chronic illnesses or disorders. One goal is
to ensure that the child be diagnosed as
early as possible so that interventions can
be started. Another is to help the child
realize as much potential as possible.
41. 1. The expected benefit from intrathecal baclofen is less spasticity, which allows the
child to have more muscle control. This
leads to more fine motor control and ambulation. The onset of action is 30 minutes,
and it peaks in 6 hours.
2. The expected benefit from intrathecal baclofen is less spasticity, which allows the
child to have more muscle control. This
leads to more fine motor control and ambulation. The onset of action is 30 minutes,
and it peaks in 6 hours.
3. If baclofen were going to work for this
child, one could tell because spasticity
would be decreased.
4. Baclofen should decrease, not increase,
spasticity.
TEST-TAKING HINT: The test taker must
know the purpose of baclofen.
42. 1. A 9-month-old should be able to sit alone,
crawl, pull up, not push food out of the
mouth (tongue thrust), and push away
when held when wanting to get down.
This child is not developing normally and
must see the primary care provider.
2. A 9-month-old should be able to sit
alone, crawl, pull up, not push food out
of the mouth (tongue thrust), and push
away when held when wanting to get
down. This child is not developing
normally and must see the primary
care provider.
OR
MUSCULAR DISORDERS
3. The mother will need help to teach the
child how to sit alone.
4. Pushing food back into the mouth may be
one strategy, but this is clearly abnormal
in a 9-month-old.
TEST-TAKING HINT: The test taker must
know normal developmental milestones.
Rolling occurs at about 4 months, sitting
alone occurs at 6 months, and pushing
food out of the mouth decreases by
4 months when the tongue thrust reflex
wanes.
43. 1, 3, 4, 5.
1. Children with spastic CP have increased deep tendon reflexes.
2. Children with spastic CP have increased
muscle tone.
3. Children with spastic CP have scoliosis.
4. Children with spastic CP have contractures of the Achilles tendons, knees,
and adductor muscles.
5. Children with spastic CP have scissoring when walking.
6. Children with spastic CP have poor control of posture.
7. Children with spastic CP have poor fine
motor skills.
TEST-TAKING HINT: The test taker must
know the typical signs of CP.
44. 1.This child is definitely at risk for skin
breakdown, but alteration in nutrition is
the priority. The child weighs 15 pounds,
which is normal for a 4-month-old. The
child is severely underweight. The mother
needs help to manage the coughing spells
while the child is being fed.
2. This is the priority nursing diagnosis
for this severely underweight child.
Weight is average for a 4-month-old.
The coughing episodes while feeding
may indicate aspiration. The parent
needs help to learn how to feed so less
coughing occurs.
3. The parent needs support in caring for
this child, but alteration in nutrition is the
priority. The child weighs 15 pounds,
which is normal for a 4-month-old. The
child is severely underweight. The parent
needs help to manage the coughing spells
while the child is being fed.
4. The child has not had a diarrheal stool for
48 hours, so the assumption is safe that the
illness is over. The child weighs 15 pounds,
which is normal for a 4-month-old. The
child is severely underweight. The parent
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needs help to manage the coughing spells
while the child is being fed.
TEST-TAKING HINT: The test taker should
convert the weight in kilograms to pounds
to have a better understanding of it.
Knowing what a 3-year-old should weigh
helps with answering this question.
45. 1. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a
child has severe speech problems, some may
assume that the child’s intelligence is severely affected when that may not be true.
2. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a
child has severe speech problems, some may
assume that the child’s intelligence is severely affected when that may not be true.
3. Many children with CP have normal
intelligence.
4. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a
child has severe speech problems, some may
assume that the child’s intelligence is severely affected when that may not be true.
TEST-TAKING HINT: Children with CP have
a wide range of intellectual abilities.
46. 1. This baby may have Werdnig-Hoffman
disease, which is characterized by progressive generalized muscle weakness
that eventually leads to respiratory failure. Respiratory compromise is the
most important complication.
2. There is no history of being unable to ingest
oral fluids; the baby is just a slow feeder.
3. This is important, but respiratory compromise is a priority in this situation.
4. There is no indication of feeding intolerance; the baby is just a slow feeder.
TEST-TAKING HINT: Consider the ABCs
in this situation: airway, breathing, and
cardiac status. These are priorities when
caring for clients.
47. 1. Babies can lose up to 10% of birth
weight but should regain it by 2 weeks
of age. Knowing how much the baby
eats can help the nurse determine if the
infant is receiving adequate nutrition.
2. The number of bowel movements will also
indicate whether the infant receives
enough formula.
3. If the infant does not awaken during the
night, then the mother may sleep all
night. Most 2-week-olds feed every 2 to
4 hours day and night.
4. How long the infant stays awake is not the
most important information. Most infants
sleep about 20 hours per day.
TEST-TAKING HINT: The “red flags” in this
question are that the baby sleeps a lot
and does not cry much, both unusual behaviors. Follow-up questions need to be
asked to determine if the infant is gaining
weight as expected.
48. 1. Werdnig-Hoffmann disease is inherited as
an autosomal-recessive trait.
2. Werdnig-Hoffmann disease is inherited as
an autosomal-recessive trait.
3. Werdnig-Hoffmann disease is inherited
as an autosomal-recessive trait.
4. Werdnig-Hoffmann disease is inherited as
an autosomal-recessive trait.
TEST-TAKING HINT: The test taker needs
to know how infants get this progressive
disease.
49. 1. Hot dogs and chips are too high in sodium
and fat.
2. Chicken is a good source of protein,
and broccoli is a good choice for naturally occurring vitamins.
3. A banana is a food toddlers usually like. A
child under 5 years should not eat nuts,
because they are a choking hazard for a
child who does not chew food well.
4. A milkshake has a high amount of fat, as
does a hamburger.
TEST-TAKING HINT: The test taker must
know good-quality foods that should be
offered to children.
50. 1. The first intervention is to check the respiratory rate of the child to see if it is
abnormal, then listen to the lung sounds,
and then check pulse oximetry.
2. The first intervention is to check the
respiratory rate of the child to see if it
is abnormal, then listen to the lung
sounds, and then check pulse oximetry.
3. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds,
and then check pulse oximetry.
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4. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds,
and then check pulse oximetry. Asking if
the child coughs at night would be helpful
information as well.
TEST-TAKING HINT: The test taker would
first count respirations to determine if the
rate is normal for a child that age. Auscultation comes next, then pulse oximetry if
needed.
51. 1. The disease etiology is frequently viral.
2. Frequently a child has had recent viral infection prior to developing neurological
symptoms.
3. This child probably has GBS, which is
an acute inflammatory demyelinating
neuropathy.
4. CNs are frequently involved.
TEST-TAKING HINT: Having a prior upper
respiratory infection usually means this
condition is not caused by bacteria, which
eliminates answers 1 and 2. That leaves
the choice between answers 3 and 4.
52. 1. Children with GBS frequently have urinary
retention, so catheterization is necessary.
Complications of GBS are usually respiratory and swallowing difficulties. Checking
the serum blood urea nitrogen is a good
thing to do, but not having voided in
10 hours is quite a lengthy time for a child.
2. The complete blood count does not provide helpful information about urinary
retention.
3. The child must be in-and-out catheterized to avoid the possibility of developing a urinary tract infection from urine
left in the bladder for too long.
4. Running water in the bathroom is a strategy used frequently to encourage patients
to void. It takes time for it to work, however, and sometimes it does not have the
intended results.
TEST-TAKING HINT: Urinary retention occurs with GBS, and catheterization is necessary in a child who has had lots of fluids
but not voided in 8 hours.
53. 1. The goal is to prevent complications related
to immobility. Efforts include maintaining
skin integrity, maintaining respiratory function, and preventing contractures. Constipation is a concern but not the primary one.
OR
MUSCULAR DISORDERS
2. Most children recover completely, so there
is no chronic sorrow.
3. The goal is to prevent complications
related to immobility. Efforts include
maintaining skin integrity, maintaining
respiratory function, and preventing
contractures.
4. GBS is a disease affecting the peripheral
nervous system, not the cardiac muscle.
TEST-TAKING HINT: The test taker must
have a basic understanding of GBS and
know that it affects the peripheral nervous
system.
54. 1. Assessing for respiratory compromise is
critical in the acute phase of the disease
process. Beginning active physical therapy
is important for helping muscle recovery
and preventing contractures.
2. Assessing for swallowing difficulties is critical in the acute phase of the disease
process. Beginning active physical therapy
is important for helping muscle recovery
and preventing contractures.
3. GBS does not affect cognitive functioning.
4. Beginning active physical therapy is
important for helping muscle recovery
and preventing contractures.
TEST-TAKING HINT: The test taker must
know the normal progress of the disease.
A hint is provided by the word recovery in
the question.
55. 1, 2, 3.
1. Symptoms in a child with myasthenia
gravis include fatigue, double vision,
ptosis, and difficulty swallowing and
chewing. This is an autoimmune disease triggered by a viral or bacterial infection. Antibodies attack acetylcholine
receptors and block their functioning.
2. Symptoms in a child with myasthenia
gravis include fatigue, double vision,
ptosis, and difficulty swallowing and
chewing.
3. Symptoms in a child with myasthenia
gravis include fatigue, double vision,
ptosis, and difficulty swallowing and
chewing.
4. Symptoms in a child with myasthenia
gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing.
5. Symptoms in a child with myasthenia
gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing.
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TEST-TAKING HINT: The test taker must
know the correct symptoms of myasthenia
gravis.
56. 1. Children with myasthenia gravis should
not play strenuous sports. They should
learn strategies to decrease stress.
2. Meditation is a good strategy to learn
to decrease stress.
3. Children with myasthenia gravis can do
many things other children do. They
should be advised not to play strenuous
sports, however, and they should learn
how to control stress.
4. Children are watched for signs of illness
because of the exacerbation of signs of
myasthenia gravis.
TEST-TAKING HINT: The test taker must
know the physiology of the illness.
57. 1. Constipation means hard stools and infrequent passage. Adding extra water
to the diet helps make the stool softer
in this age child.
2. It is not recommended to add corn syrup
or honey to the bottle of a child younger
than 12 months because of the danger of
botulism.
3. It is not recommended to give an infant a
glycerine suppository for hard infrequent
stools; constipation should be managed
with dietary changes.
4. Adding additional water daily is the easiest
first step in handling constipation.
TEST-TAKING HINT: The test taker must
know how to treat constipation in an infant, which is different from treating it in
a child.
58. 1. A child less than 7 years of age and not
fully immunized who has a tetanusprone wound should receive DTaP
vaccine to prevent tetanus. Tetanusprone wounds include puncture
wounds and those contaminated with
dirt, feces, or soil.
2. An antibiotic probably will be started,
but administering DTaP vaccine is the
priority.
3. Wounds are routinely cleansed with soap
and water. Hydrogen peroxide does not
clean better.
4. This child can be cared for in the clinic.
TEST-TAKING HINT: The test taker must
know about wound care and which
wounds are considered contaminated.
59. 3, 4, 5.
1. A brachial plexus injury in an infant (resulting from tearing or stretching of a
nerve) usually occurs with large babies and
breech delivery.
2. A brachial plexus injury in an infant (resulting from tearing or stretching of a
nerve) usually occurs with large babies and
breech delivery.
3. The infant will have an absent Moro
reflex on one side and no sensory loss.
4. The infant will have an absent Moro
reflex on one side and no sensory loss.
5. The injury may be associated with a
fractured clavicle.
TEST-TAKING HINT: The test taker must
know what a brachial plexus is and how an
injury would affect it.
60. 1. C1–C5 is too high, as the patient has
the use of the arms and sensation to the
nipple line.
2. C5–C7 is too high, as the patient still has
the use of the arms.
3. Damage at T1–T4 manifests at or just
below the nipple line. Every area below
would be affected.
4. Sensation ends at the nipple line, so T5–T12
is too low.
5. L2–L5 is too low, as the patient has sensation only to the nipple line.
6. S1–S5 is too low.
TEST-TAKING HINT: Deficits occur at and
below the level of injury.
61. 2, 3, 5.
1. A decrease in blood pressure does not
contribute to autonomic dysreflexia. Increased blood pressure usually occurs with
autonomic dysreflexia.
2. Autonomic dysreflexia may be caused
by abdominal pressure from a fecal
impaction.
3. An overdistended bladder is usually the
precipitating factor causing an increase
in abdominal pressure.
4. Fecal impaction and constipation, not diarrhea, can be causes of autonomic dysreflexia.
5. Tight clothing can increase pressure to
the central core of the body.
6. Hyperthermia does not cause autonomic
dysreflexia.
TEST-TAKING HINT: Autonomic dysreflexia
most often occurs due to an irritating
stimulus within the body below the level
of spinal cord injury.
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Orthopedic
Disorders
12
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Abduction
Adduction
Growth plate
Osteomyelitis
Pavlik harness
Pes cavus
Pes planus
Synovial fluid
ABBREVIATIONS
Developmental dysplasia of the hip (DDH)
Intravenous fluids (IVF)
Juvenile rheumatoid arthritis (JRA)
Nonsteroidal anti-inflammatory drugs
(NSAIDs)
Osteogenesis imperfect (OI)
Patient-controlled analgesia (PCA)
Slipped capital femoral epiphysis (SCFE)
Systemic lupus erythematosus (SLE)
QUESTIONS
1. Which would the nurse expect to assess on a 3-week-old infant with developmental
dysplasia of the hip (DDH)?
1. Excessive hip abduction.
2. Femoral lengthening of an affected leg.
3. Asymmetry of gluteal and thigh folds.
4. Pain when lying prone.
2. Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)?
1. Put socks on over the foot pieces of the harness to help stabilize the harness.
2. Use lotions or powder on the skin to prevent rubbing of straps.
3. Remove harness during diaper changes for ease of cleaning diaper area.
4. Check under the straps at least two to three times daily for red areas.
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3. Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all
that apply.
1. Duck gait.
2. Pain.
3. Osteoarthritis in adulthood.
4. Osteoporosis in adulthood.
5. Increased flexibility of the hip joint in adulthood.
4. The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the
teaching as successful when the parent states that clubfoot is best treated when?
1. Immediately after diagnosis.
2. At age 4 to 6 months.
3. Prior to walking (age 9 to 12 months).
4. After walking is established (age 15 to 18 months).
5. Which is the definition of talipes varus?
1. An inversion or bending inward of the foot.
2. An eversion or bending outward of the foot.
3. A high arch of the foot.
4. A low arch (flatfoot) of the foot.
6. The nurse tells the parent that other conditions can be associated with congenital
clubfoot. Select all that apply.
1. Myelomeningocele.
2. Cerebral palsy.
3. Diastrophic dwarfism.
4. Breech position in utero.
5. Prematurity.
6. Fetal alcohol syndrome.
7. When planning a rehabilitative approach for a child with osteogenesis imperfecta
(OI), the nurse should prevent which of the following? Select all that apply.
1. Positional contractures and deformities.
2. Bone infection.
3. Muscle weakness.
4. Osteoporosis.
5. Misalignment of lower extremity joints.
8. Which classification of osteogenesis imperfecta (OI) is lethal in utero and in infancy?
1. Type I.
2. Type II.
3. Type III.
4. Type IV.
9. When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse
should include which of the following? Select all that apply.
1. Discourage future children because the condition is inherited.
2. Provide education about the child’s physical limitations.
3. Give the parents a letter signed by the primary care provider explaining OI.
4. Provide information on contacting the Osteogenesis Imperfecta Foundation.
5. Encourage the parents to treat the child like their other children.
6. Encourage use of calcium to decrease risk of fractures.
10. Which factor(s) is/are associated with slipped capital femoral epiphysis (SCFE)?
Select all that apply.
1. Obesity.
2. Female gender.
3. African descent.
4. Age of 5 to 10 years.
5. Pubertal hormonal changes.
6. Endocrine disorders.
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11. Which should be obtained to make a diagnosis of slipped capital femoral epiphysis
(SCFE)?
1. A history of hip trauma.
2. A physical examination of hip, thigh, and knees.
3. A complete blood count.
4. A radiographic examination of the hip.
12. Which should be included in teaching a family about post-surgical care for slipped
capital femoral epiphysis (SCFE)? Select all that apply.
1. The patient will receive help with weight-bearing ambulation 24 to 48 hours after
surgery.
2. Monitoring of pain medication to prevent drug dependence.
3. Instruction on pin site care.
4. Offering low-calorie meals to encourage weight loss.
5. Correct use of crutches by the patient.
6. Outpatient physical therapy for 6 to 8 weeks.
13. Which would the nurse assess in a child diagnosed with osteomyelitis? Select all
that apply.
1. Unwillingness to move affected extremity.
2. Severe pain.
3. Fever.
4. Previous closed fracture of an extremity.
5. Redness and swelling at the site.
14. The parent of a child diagnosed with osteomyelitis asks how the child acquired the
illness. Which is the nurse’s best response?
1. “Direct inoculation of the bone from stepping barefoot on a sharp stick.”
2. “An infection from a scratched mosquito bite carried the infection through the
bloodstream to the bone.”
3. “The blood supply to the bone was disrupted because of the child’s diabetes.”
4. “An infection of the upper respiratory tract.”
15. A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours.
The child is allergic to amoxicillin. Vital signs are T 101.8°F (38.8°C), BP 100/60,
P 96, R 24. Which is the primary reason for surgical treatment?
1. Young age.
2. Drug allergies.
3. Nonresponse to intravenous antibiotics.
4. Physician preference.
16. The nurse expects the blood culture report of an 8-year-old with septic arthritis to
grow which causative organism?
1. Streptococcus pneumoniae.
2. Escherichia coli.
3. Staphylococcus aureus.
4. Neisseria gonorrhoeae.
17. Which instruction(s) should the nurse give the parents of an adolescent with slipped
capital femoral epiphysis (SCFE)? Select all that apply.
1. Continue upper body exercises to limit loss of muscle strength.
2. Do not turn the teen in bed when complaining of pain.
3. Provide homework, computer games, and other activities to decrease boredom.
4. Do most activities of daily living for the teen.
5. Expect expressions of anger and hostility.
6. Continue setting limits on behavior.
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18. The parent of a 3-week-old states that the infant was recasted this morning for
clubfoot and has been crying for the past hour. Which intervention should the nurse
suggest the parent do first?
1. Give pain medication.
2. Reposition the infant in the crib.
3. Check the neurocirculatory status of the foot.
4. Use a cool blow-dryer to blow into the cast to control itching.
19. Which should the nurse include in the teaching plan for a child who had surgery to
correct bilateral clubfeet and had the casts removed? Select all that apply.
1. “Your child will need to wear a brace on the feet 23 hours a day for at least 2 months.”
2. “Your child should see an orthopedic surgeon regularly until the age of 18 years.”
3. “Your child will not be able to participate in sports that require a lot of running.”
4. “Your child may have a recurrence of clubfoot in a year or more.”
5. “Most children treated for clubfeet develop feet that appear and function normally.”
6. “Most children treated for clubfeet require surgery at puberty.”
20. Which parts of the body should the nurse assess on a child in a spica cast? List the
relevant label(s) from the following figure.
B
A
C
D
21. When a child is suspected of having osteomyelitis, the nurse can prepare the family
to expect which of the following? Select all that apply.
1. Pain medication is contraindicated so that symptoms are not masked.
2. Blood cultures will be obtained.
3. Pus will be aspirated from the subperiosteum.
4. An intravenous line with antibiotics will be started.
5. Surgery will be necessary.
22. Where should the top of the crutch bar be in relation to the axilla?
23. Select the number of inches lateral to the heel where a crutch should be placed.
1. 1 to 3.
2. 4 to 5.
3. 6 to 8.
4. 9 to 10.
24. Which is most important when teaching a parent about preventing osteomyelitis?
1. Parents can stop worrying about bone infection once their child reaches
school age.
2. Parents need to clean open wounds thoroughly with soap and water.
3. Children will always get a fever if they have osteomyelitis.
4. Children should wear long pants when playing outside because their legs might
get scratched.
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25. The nurse caring for a child with osteomyelitis assesses poor appetite. Which intervention(s) is/are most appropriate for this child? Select all that apply.
1. Offer high-calorie liquids.
2. Offer favorite foods.
3. Do not worry about intake, as appetite loss is expected.
4. Suggest intravenous removal to encourage oral intake.
5. Decrease pain medication that might cause nausea.
6. Offer frequent small meals.
26. The nurse on the pediatric floor is receiving a child with the possible diagnosis of
septic arthritis of the elbow. Which would the nurse expect on assessment? Select all
that apply.
1. Resistance to bending the elbow.
2. Nausea and vomiting.
3. Fever.
4. Bruising of the elbow.
5. Swelling of the elbow.
6. A history of nursemaid’s elbow as a toddler.
27. A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is
the most likely reason the child will not wear it for that long?
1. Pain from the brace.
2. Difficulty in putting the brace on.
3. Self-consciousness about appearance.
4. Not understanding what the brace is for.
28. A spinal curve of less than
not require treatment for scoliosis.
degrees that is nonprogressive does
29. A 13-year-old just returned from surgery for scoliosis. Which nursing intervention(s)
is/are appropriate in the first 24 hours? Select all that apply.
1. Assess for pain.
2. Logroll to change positions.
3. Get the teen to the bathroom 12 to 24 hours after surgery.
4. Check neurological status.
5. Monitor blood pressure.
30. A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous
opioid analgesia. What should the nurse do first?
1. Give more pain medication.
2. Perform a neuromuscular assessment.
3. Call the surgeon for orders.
4. Tell the child to wait another hour for the medication to work.
31. A 14-year-old with osteogenesis imperfecta (OI) is confined to a wheelchair. Which
nursing interventions will promote normal development? Select all that apply.
1. Encourage participation in groups with teens who have disabilities or chronic illness.
2. Encourage decorating the wheelchair with stickers.
3. Encourage transfer of primary care to an adult provider at age 18 years.
4. Allow the teen to view the radiographs.
5. Help the teen set realistic goals for the future.
6. Discourage discussion of sexuality, as the child is not likely to date.
32. After the birth of an infant with clubfoot, the nursery nurse should do which when
instructing the parents? Select all that apply.
1. Speak in simple language about the defect.
2. Avoid the parents unless providing direct care so they can grieve privately.
3. Keep the infant’s feet covered at all times.
4. Present the infant as precious; emphasize the well-formed parts of the body.
5. Tell the parent that defects could be much worse.
6. Be prepared to answer questions multiple times.
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33. The nurse should be suspicious of which condition in the following figure?
34. Name the harness in the following figure.
35. Which condition is the harness used for in the following figure?
36. When instructing a family about care of an orthosis, the nurse should emphasize
which of the following?
1. Clean the brace with diluted bleach.
2. Dry the brace over a heater or in the sun.
3. Clean the brace weekly with mild soap and water.
4. Return the brace to the orthopedic surgeon for cleaning.
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37. When teaching parents about osteosarcoma, the nurse knows instruction has been
successful when a parent says that this type of cancer is common in which age group?
1. Infancy.
2. Toddlers.
3. School-aged children.
4. Adolescents.
38. A child with osteosarcoma is going to receive chemotherapy before surgery. Which
statement by the parents indicates they understand the side effect of neutropenia?
1. “My child will be more at risk for diarrhea.”
2. “My child will be more at risk for infection.”
3. “My child’s hair will fall out.”
4. “My child will need to drink more.”
39. Which is most important to discuss with an adolescent who is going to have a leg
amputation for osteosarcoma?
1. Pain.
2. Spirituality.
3. Body image.
4. Lack of coping.
40. Which would be the best nursing intervention for a child with phantom pain after an
amputation?
1. Tell the child that the pain does not exist.
2. Request a PCA pump from the physician for pain management.
3. Encourage the child to rub the stump.
4. Provide Elavil to help with pain.
41. Use the following labels to name the places on the bone in the following figure.
1.
2.
3.
4.
5.
6.
Epiphysis.
Diaphysis.
Epiphyseal plate.
Medullary cavity.
Calcaneus bone.
Compact bone.
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42. The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a
common site?
1. Shaft.
2. Growth plate.
3. Ball of the femur.
4. Bone marrow.
43. Which nursing diagnosis is most important for a child with Ewing sarcoma who will
be undergoing chemotherapy?
1. Risk for fluid volume deficit.
2. Potential for chronic pain.
3. Risk for skin impairment.
4. Ineffective airway clearance.
44. A child is going to receive radiation for Ewing sarcoma. Which of the following is
the best nursing intervention to prevent skin breakdown during therapy?
1. Advise the child to wear loose-fitting clothes to minimize irritation.
2. Advise the child to use emollients to prevent dry skin.
3. Apply cold packs nightly to reduce the warmth caused by the treatments.
4. Apply hydrocortisone to soothe itching from dry skin.
45. A child with Ewing sarcoma is undergoing a limb salvage procedure. Which
statement indicates the parents understand the procedure?
1. “Our child will have a bone graft to save the limb.”
2. “Our child will need follow-up lengthening procedures.”
3. “Our child will need shorter shirt sleeves.”
4. “Our child will not need chemotherapy.”
46. A child with Ewing sarcoma is receiving chemotherapy and is experiencing severe
nausea. The nurse has to administer Ativan at 0.04 mg/kg, and the child weighs
65 lb. What dose should the nurse administer?
47. The nurse is explaining rhabdomyosarcoma cancer to an adolescent. From which of
the following muscles does the cancer arise?
1. Skeletal.
2. Cardiac.
3. Striated.
4. Connective.
48. A child is diagnosed with stage IV rhabdomyosarcoma, and the parent asks what that
means. The nurse provides which of the following explanations?
1. The tumor is limited to the organ site.
2. There is regional disease from the organ involved.
3. There is distant metastatic disease.
4. The disease is limited to the lymph nodes.
49. The nurse evaluates teaching as successful when the parent explains that an excisional
biopsy is done for which reason?
1. To find metastatic disease.
2. To remove all metastatic disease.
3. To confirm the type of metastatic disease.
4. To treat metastatic disease.
50. It is recommended that a child with metastatic rhabdomyosarcoma undergo a bone
marrow transplant. Education regarding life-threatening side effects should include:
1. Diarrhea.
2. Fever.
3. Skin breakdown.
4. Tumor shrinkage.
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51. Select all that apply to the care of a child with a retroperitoneal rhabdomyosarcoma.
1. Acute pain.
2. Risk for impaired urinary elimination.
3. Impaired gas exchange.
4. Self-care deficit.
5. Risk for constipation.
52. The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic
arthritis (JIA). The nurse would evaluate the teaching as successful when the parent
is able to say that the disorder is caused by the:
1. Breakdown of osteoclasts in the joint space causing bone loss.
2. Loss of cartilage in the joints.
3. Build-up of calcium crystals in joint spaces.
4. Immune-stimulated inflammatory response in the joint.
53. Which would the nurse teach an adolescent is a complication of corticosteroids used
in the treatment of juvenile idiopathic arthritis (JIA)?
1. Fat loss.
2. Adrenal stimulation.
3. Immune suppression.
4. Hypoglycemia.
54. Which would the nurse teach a patient when NSAIDs are prescribed for treating
juvenile idiopathic arthritis (JIA)?
1. Take with food.
2. Take on an empty stomach.
3. Blood levels are required for drug dosages.
4. Good oral hygiene is needed.
55. Why are chemotherapeutic agents such as methotrexate and cyclophosphamide
sometimes used to treat juvenile idiopathic arthritis (JIA)?
1. Effective against cancer-like JIA.
2. Affect the immune system.
3. Are similar to NSAIDs.
4. Are absorbed into the synovial fluid.
56. One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical
mobility. Select all that apply.
1. Give pain medication prior to ambulation.
2. Assist with range-of-motion activities.
3. Encourage the child to eat a high-fat diet.
4. Provide oxygen as necessary.
5. Use nonpharmacological methods, such as heat.
57. The nurse is teaching the parent of a child diagnosed with systemic lupus erythematosus (SLE). The nurse evaluates the teaching as effective when the parent states:
1. “The cause is unknown.”
2. “There is no genetic involvement.”
3. “Drugs are not a trigger for the illness.”
4. “Antibodies improve disease outcome.”
58. A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythematosus (SLE). On assessment, the nurse expects the child to have:
1. Leukemia.
2. Malar rash.
3. Weight gain.
4. Heart failure.
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59. Which is an important nursing intervention to teach about photosensitivity to the
parents of a child with systemic lupus erythematosus (SLE)?
1. Regular clothing is appropriate for sun exposure.
2. Sunscreen application is necessary for protection.
3. Teenage patients cannot participate in outdoor sports.
4. Uncovered fluorescent lights offer no danger.
60. Which is an important nursing intervention to monitor in a child with systemic lupus
erythematosus (SLE) and renal involvement?
1. Monitor weight.
2. Check for uric salts in urine.
3. Watch for hypotension.
4. Check for protein in urine.
61. Because estrogen is a possible trigger for a systemic lupus erythematosus (SLE) flare,
advice for a teenager who may become sexually active includes which of the following? Select all that apply.
1. Use Ortho Tri-Cyclen.
2. Use Depo-Provera.
3. Practice abstinence.
4. Use condoms.
5. Use Ortho Evra.
62. A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula
fracture that has been casted. Which is/are an early sign(s) of compartment
syndrome in this child? Select all that apply.
1. Edema.
2. Numbness.
3. Severe pain.
4. Weak pulse.
5. Anular rash.
63. Nursing care of a child with a fractured extremity in whom there is suspected
compartment syndrome includes which of the following? Select all that apply.
1. Assess pain.
2. Assess pulses.
3. Elevate extremity above the level of the heart.
4. Monitor capillary refill.
5. Provide pain medication as needed.
64. Which is the nurse’s best explanation to the parent of a toddler who asks what a
greenstick fracture is?
1. It is a fracture located in the growth plate of the bone.
2. Because children’s bones are not fully developed, any fracture in a young child is
called a greenstick fracture.
3. It is a fracture in which a complete break occurs in the bone, and small pieces of
bone are broken off.
4. It is a fracture that does not go all the way through the bone.
65. A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth
plate. When providing information to the parents, the nurse should indicate that:
1. This is a serious injury that could cause long-term growth issues.
2. The fracture usually heals within 6 weeks without further complications.
3. The child will never be able to play contact sports.
4. Fractures involving the growth plate require pain medication.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. In DDH, a newborn can have excessive hip
adduction.
2. In DDH, an appearance of femoral shortening is frequently present on the affected
side.
3. In DDH, asymmetrical thigh and gluteal
folds are frequently present.
4. Infants do not experience pain from this
condition.
TEST-TAKING HINT: If the test taker knows
that DDH decreases smooth movement
of the femoral head, then answers 1 and
2 can be eliminated because they indicate
increased movement of the femur.
2. 1. Socks should be put on under the straps to
prevent rubbing of the skin. The harness is
stable if fitted correctly.
2. Lotions and powders tend to cake and
irritate under the straps. Their use is not
recommended.
3. The harness is not to be removed except in
specific conditions and after instruction on
removal and refitting. Diapering is easily
done with the harness in place.
4. Checking under straps frequently is
suggested to prevent skin breakdown.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because the question
is about skin breakdown, not harness fit.
3. 1, 2, 3.
1. Due to abnormal hip joint function, the
patient’s gait is stiff and waddling.
2. Due to abnormal femoral head placement, the patient may experience pain
and decreased flexibility in adulthood.
3. Due to abnormal femoral head placement,
the patient may experience osteoarthritis
in the hip joint in adulthood.
4. There is no increased risk for osteoporosis.
5. There is no increased flexibility of the hip
joint in adulthood.
TEST-TAKING HINT: If the test taker knows
that untreated DDH leads to decreased
smooth movement of hip joint, answer
5 can be eliminated.
4. 1. The best outcomes for clubfoot are seen
if casting begins as soon as the diagnosis
is made.
2. Although casting helps if started in the
newborn period, the delay of even 4 to
6 months postpones the positive outcome.
3. Infants of 9 months are already pulling up
to stand and taking steps. Clubfoot puts
weight on surfaces of feet that are not
meant for weightbearing.
4. Clubfoot does not allow for normal gait,
and the delay will decrease the likelihood of
a successful outcome.
TEST-TAKING HINT: The general principle of
early treatment of orthopedic problems
should lead to the correct answer.
Talipes varus is an inversion of the foot.
Talipes valgus is an eversion of the foot.
Pes cavus is a high arch of the foot.
Pes planus is flatfoot.
TEST-TAKING HINT: The test taker must
know the definition of terms.
5. 1.
2.
3.
4.
6. 1, 2, 3.
1. There is an association between
myelomeningocele and congenital
clubfoot.
2. There is an association between some
forms of cerebral palsy and congenital
clubfoot.
3. There is an association between
diastrophic dwarfism and congenital
clubfoot.
4. Breech position is not associated with
congenital clubfoot. It is associated
with DDH.
5. There is no association between prematurity and congenital clubfoot.
6. Fetal alcohol syndrome is not associated
with clubfoot.
TEST-TAKING HINT: The test taker could
look at other congenital deformities to gain
a clue to an association to clubfoot.
7. 1, 3, 4, 5.
1. A long-term goal in caring for a child
with OI is to prevent contractures and
deformities.
2. There is no increased risk for bone infection in OI.
3. A long-term goal in caring for a child
with OI is to prevent muscle weakness.
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4. A long-term goal in caring for a child
with OI is to prevent osteoporosis.
5. A long-term goal in caring for a child
with OI is to prevent misalignment of
lower extremity joints.
TEST-TAKING HINT: The test taker should
think about general nursing considerations
for children with fractures and choose
answers 1, 3, 4, and 5.
8. 1. Type I is the most common form. It
is characterized by little deformity,
variable fractures, blue sclera, hearing
loss common in the 20s, and a normal
life span.
2. Type II is lethal in utero and in infancy
because of multiple fractures and
deformities and underdeveloped lungs.
3. Type III is characterized by fractures,
deformities, and short stature. Patients
rarely live to age 30 years.
4. Type IV is similar to type I but not
associated with blue sclera.
TEST-TAKING HINT: The test taker might be
tempted to choose type IV, thinking that
the higher number (IV) is the most severe
form of OI.
9. 2, 3, 4.
1. Genetic counseling should be provided as
part of long-term care so that the parents
can make an informed decision about
future children.
2. The nurse should provide education
about the child’s physical limitations so
that physical therapy and appropriate
activity can be encouraged.
3. OI is frequently confused with child
abuse. Carrying a letter stating that the
child has OI and what that condition
looks like can ease the stressors of an
emergency department visit.
4. The Osteogenesis Imperfecta Foundation
is an organization that can provide information and support for a family with a
child with the condition.
5. Children with OI must be treated with
careful handling and cannot be allowed to
participate in all activities that unaffected
siblings are allowed.
6. There is no support for the use of additional
calcium to decrease fractures.
TEST-TAKING HINT: The test taker can eliminate answer 1 because it is based on the
nurse’s values, not necessarily those of the
parents.
10. 1, 5, 6.
1. Obesity increases the risk of SCFE by
stressing the epiphyseal plate.
2. SCFE is more common in males.
3. SCFE is more common in whites.
4. SCFE is most common from the ages of
10 to 16 years.
5. SCFE is most common during
pubertal hormonal changes.
6. SCFE is associated with endocrine
disorders.
TEST-TAKING HINT: If the test taker knows
that SCFE is most common during rapid
growth, answer 4 can be eliminated, and
answer 5 can be chosen.
11. 1. In most cases of SCFE, there is no history
of trauma to the hip.
2. Physical examination may reveal some
restriction of rotation of the hip, but it is
not diagnostic.
3. There is no change in blood laboratory
values with SCFE. Radiographic examination is the only definitive tool for diagnosis of SCFE.
4. Radiographic examination is the only
definitive diagnostic tool for SCFE.
TEST-TAKING HINT: The most definitive
tool in assessing a hip is radiographic
examination.
12. 3, 5.
1. Ambulation is to be non–weight bearing
with crutches until range of motion is
painless. This is usually 4 to 8 weeks.
2. Pain medication is to be administered
regularly during hospitalization to provide comfort to the patient and encourage
cooperation with daily activities and
ambulation. Drug dependence for the
post-operative patient is not a significant
concern.
3. The parents will be assessing pin sites
for infection and stability upon discharge. Instructions on care should
be demonstrated for and then by the
parents.
4. Although obesity is often a factor in
SCFE, the patient requires adequate
caloric intake for healing and recovery
post-operatively. Obesity issues can be
addressed after surgical recovery.
5. Instruction on crutch usage will be
given prior to discharge. Crutch walking will not be done during the early
post-operative stage.
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6. Outpatient physical therapy is not usually
necessary.
TEST-TAKING HINT: The test taker should
be able to rule out answer 2 by understanding the safe use of pain medication
in the immediate post-operative period.
13. 1, 2, 3, 5.
1. Pain in an extremity leads to resistance
to movement.
2. Pain is frequently severe in osteomyelitis.
3. Fever is present in the acute phase of
the illness.
4. Osteomyelitis can sometimes be seen after
a direct inoculation of an open fracture.
There is no increased risk after a closed
fracture.
5. Redness and swelling occur because of
the infection.
TEST-TAKING HINT: The test taker can rule
out answer 4 if it is understood that a
closed fracture does not increase the risk
of bone infection.
14. 1. Although osteomyelitis can occur from
direct inoculation, inoculation is not the
most common cause.
2. Infection through the bloodstream is
the most likely cause of osteomyelitis
in a child.
3. Although osteomyelitis can occur because
of blood supply disruption, that is more
likely to occur in older adults. Diabetes
does increase the risk of osteomyelitis,
but diabetes is more common in older
adults.
4. A viral upper respiratory infection is not
the most likely cause.
TEST-TAKING HINT: The age of the patient
is important in choosing the most likely
cause of the disease.
15. 1. All children with osteomyelitis are treated
initially with intravenous antibiotics, regardless of age.
2. Although drug allergies are a concern,
antibiotic choices can be made to
accommodate patients with specific
drug allergies.
3. If a patient does not respond to
an appropriate antibiotic within
48 hours, surgery may be indicated.
4. Although there is some difference of
opinion about the use of surgery in
the treatment of osteomyelitis, the
standard initial treatment is intravenous
antibiotics.
TEST-TAKING HINT: Answer 4 should be
eliminated because patient treatment
should be based on evidence-based
practice.
16. 1. S. pneumoniae is more common in children younger than age 5 years, but it is
not the most common organism.
2. E. coli is more common in neonates, but it
is also not the most common cause.
3. S. aureus is a common organism found
on the skin and is frequently the cause
of septic arthritis.
4. N. gonorrhoeae should be considered in
sexually active patients, but it is not the
most common organism.
TEST-TAKING HINT: The age of the child is
important in choosing the correct answer.
17. 1, 3, 5, 6.
1. Immobilization can lead to a decrease
in muscle strength. Upper body exercises should be continued soon after
surgery.
2. Although turning the patient in bed after
surgery may be painful, it is essential that
parents and the patient know that it is
necessary to prevent skin ulcerations and
promote healing.
3. It is important for this patient to continue as many normal activities as possible. This should include schoolwork
and leisure activities.
4. To promote independence that is essential
for a teenager, this patient should be
encouraged to continue activities of daily
living.
5. Some expressions of anger and hostility are normal, as this adolescent is
losing some independence with this
immobility.
6. Continuation of setting limits on
behavior is important to keep as
much normalcy as possible.
TEST-TAKING HINT: The test taker needs to
understand the developmental need for
independence in this age group.
18. 1. The cause of the crying needs to be
determined prior to administering pain
medication.
2. Although this is a good choice, it is not
the first intervention.
3. Checking the neurocirculatory status
of the foot is the highest priority.
4. Although this is a good choice for cast
discomfort, it is not the first choice.
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TEST-TAKING HINT: The test taker should
prioritize nursing interventions and know
that safety needs are paramount.
19. 1, 2, 4, 5.
1. After the final casting, bracing is
required for 23 to 24 hours per day
for 2 months. This decreases the
likelihood of a recurrence.
2. Because clubfoot can recur, it is important to have regular follow-up with the
orthopedic surgeon until age 18 years.
3. After treatment, most children are able to
participate in any sport.
4. Even with proper bracing, there may
be a recurrence.
5. Most children treated for clubfeet
develop normally appearing and
functioning feet.
6. Most children do not require surgery at
puberty.
TEST-TAKING HINT: If the test taker is
aware that clubfoot can recur, providing
instruction that includes long-term
follow-up care will help in selecting
answers.
20. C, D. The nurse needs to assess areas
under the cast for drainage through the
cast and assess neurocirculatory status
of the feet.
TEST-TAKING HINT: The test taker should
know to check for neurocirculatory status
and wound drainage.
21. 2, 3, 4.
1. Medication will be given regularly to help
with the pain.
2. Blood cultures will be obtained.
3. Pus will be aspirated from the
subperiosteum.
4. Antibiotics will be given via an
intravenous line.
5. Surgery is indicated only when
medication fails.
TEST-TAKING HINT: If the test taker is
unsure of specific care for osteomyelitis,
standard nursing care for infection can
lead to correct choices.
22. The crutch bar should not put pressure on
nerves in the axilla.
TEST-TAKING HINT: The axillae do not rest
on the crutch bar.
23. 1. This position does not provide the best
protection for balance and stability.
2. This position does not provide the best
protection for balance and stability.
3. This position provides the best protection for balance and stability.
4. This position does not provide the best
protection for balance and stability.
TEST-TAKING HINT: Consider the stance
that is best for balance when standing.
24. 1. Osteomyelitis can occur in children older
than school age.
2. Because bacteria from an open wound
can lead to osteomyelitis, thorough
cleaning with soap and water is the
best prevention.
3. Children with osteomyelitis do not always
have a fever.
4. It is not necessary to require children to
wear long pants whenever playing outside.
TEST-TAKING HINT: The test taker can
eliminate answers 1 and 3 because they do
not address prevention.
25. 1, 2, 6.
1. High-calorie liquids are sometimes
received better when the child has a
poor appetite.
2. Offering favorite foods can sometimes
tempt the child to eat, even with a
poor appetite.
3. Although decreased appetite is expected,
it is something that needs nursing intervention in order to promote healing.
4. An intravenous line is necessary for
antibiotics, so it cannot be removed to
encourage oral intake.
5. Although some pain medications cause
nausea, their use is important. If patients
are in pain, they are not likely to want to
eat.
6. Small, frequent meals might increase
daily caloric intake.
TEST-TAKING HINT: Using routine nursing
interventions for decreased appetite can
lead to the correct answers.
26. 1, 2, 3, 5.
1. Infection of the elbow joint can cause
pain that leads to protecting the joint
and resisting movement.
2. Infection of the elbow may cause
generalized nausea and vomiting.
3. Infection of the elbow frequently
causes fever.
4. There is no bruising with septic arthritis.
5. Septic arthritis can cause swelling of
the joint.
6. There is no increased risk with a history
of nursemaid elbow.
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TEST-TAKING HINT: The test taker can rule
out answer 6, as risk of infection is not
related to past injury.
27. 1. Putting on the brace is not painful.
2. Putting on the brace is not difficult.
3. Children this age are very conscious
of their appearance and fitting in with
their peers, so they might be very
resistant to wearing a brace.
4. Although a child this age might not fully
understand how the brace helps the condition, that would not be the most likely
cause of noncompliance.
TEST-TAKING HINT: The test taker must
understand the development of children.
28. 20. A 20-degree spinal curve that is nonprogressive will not disfigure or interfere
with normal functioning, so it is not
treated with bracing or surgery.
TEST-TAKING HINT: The test taker must
know about treatment for scoliosis.
29. 1, 2, 4, 5.
1. General post-operative nursing interventions include assessing for pain.
2. Specific to scoliosis surgery, logrolling
is the means of changing positions.
3. Patients may not be upright less than
24 hours post-operatively.
4. It is essential to check neurological
status in a patient who just had scoliosis surgery.
5. General post-operative nursing interventions include assessing vital signs.
TEST-TAKING HINT: The test taker can use
general post-operative care principles to
lead to several correct answers.
30. 1. The nurse needs to assess the child prior
to giving more pain medication.
2. The nurse looks for the source of the
pain by performing a neuromuscular
assessment.
3. If the neuromuscular assessment is normal, the nurse might need to call the
surgeon for further orders.
4. The child should have relief from pain after
about 20 to 30 minutes of receiving the intravenous medication, so waiting is not correct.
TEST-TAKING HINT: The surgeon should
be called only after an assessment of the
patient is done. The test taker can rule
out answer 3.
31. 1, 2, 4, 5.
1. This patient is trying to become more
independent and trying to fit in with the
peer group. Encouraging socializing
with peers who face similar challenges
alleviates feelings of isolation.
2. Decorating the wheelchair encourages
the patient to assume independence in
self-care.
3. It is not necessarily appropriate to transfer health care at age 18 years. If the teen
is with a provider who has known the patient and family most of the teen’s life, it
might be best to remain with that
provider for several more years.
4. Allowing the patient to view radiographs
encourages the patient to assume
self-care.
5. Helping the patient set realistic
goals for the future encourages
independence.
6. It is appropriate for the nurse to discuss
sexuality with this patient. Being confined
to a wheelchair does not preclude dating
or becoming intimate.
TEST-TAKING HINT: The test taker can use
normal growth and development to help
choose correct answers.
32. 1, 4, 6.
1. The parents will likely be shocked
immediately after the birth of the child.
To facilitate their understanding, the
nurse should speak in simple terms.
2. Avoiding the parents is not therapeutic.
3. The baby should be shown to the parents
as are all newborns, without hiding the
clubfoot.
4. The baby should be shown to the parents as are all newborns, emphasizing
the well-formed parts of the body.
5. Negating the parents’ grieving is not
therapeutic.
6. Information may need to be repeated
as the family begins to absorb the
information.
TEST-TAKING HINT: The test taker can
draw on therapeutic communication skills
to choose correct answers.
33. DDH. The asymmetry of the thigh folds
suggests DDH.
34. Pavlik harness. The Pavlik harness is used
to treat DDH diagnosed in the newborn
period.
TEST-TAKING HINT: The harness places the
hip joints in abduction.
35. It is used for DDH. The Pavlik harness is
used to treat DDH in neonates.
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TEST-TAKING HINT: Being able to answer
previous questions correctly can sometimes help with later questions.
36. 1. The use of bleach can damage the brace.
2. Drying in direct sunlight or on a heater
can warp the brace.
3. An orthosis should be cleaned weekly
with mild soap and water.
4. The brace can be safely cleaned at home.
TEST-TAKING HINT: The test taker can rule
out answer 4, because equipment care
would not be confined to a physician’s
office.
37. 1. Osteosarcoma is a common cancer of
adolescents.
2. Osteosarcoma is a common cancer of
adolescents.
3. Osteosarcoma is a common cancer of
adolescents.
4. Osteosarcoma is a common cancer of
adolescents.
TEST-TAKING HINT: The test taker must
remember that pediatric cancers usually
develop during times of peak growth.
Adolescence is the greatest time of peak
bone growth.
38. 1. Diarrhea is a side effect of chemotherapy,
not neutropenia.
2. Neutropenia makes a child more at
risk for infection, because the immune
system is compromised due to the
chemotherapy.
3. Alopecia is a side effect of chemotherapy.
4. Dehydration is a potential side effect of
chemotherapy.
TEST-TAKING HINT: Neutropenia consists of
neutro- (meaning “neutrophils,” a subset
of the white blood cells) and -penia
(meaning “low or decreased”).
39. 1. Pain is a common concern but adolescents are more concerned about their
body image.
2. In general, adolescents are more concerned
with their body image and not spirituality.
3. Body image is a developmental issue
for adolescents and influences their
acceptance of themselves and by peers.
4. Body image is more of a concern for
adolescents and should be addressed first
by the nurse. Lack of coping is not a
priority at this time.
TEST-TAKING HINT: The question asks for
specific versus general anticipatory guidance issues.
40. 1. This is not a helpful intervention.
2. PCA is not necessary for phantom pain.
3. Rubbing the stump is not helpful and
possibly harmful to healing.
4. Elavil is a medication for nerve pain that
is helpful in relieving phantom pain.
TEST-TAKING HINT: Knowing that phantom
pain is due to nerve pain from the lost
limb enables elimination of answer 2.
41.
Calcaneus bone
Epiphysis
Epiphyseal plate
Diaphysis
Medullary cavity
Compact bone
TEST-TAKING HINT: The test taker should
look at each word and think about the
parts of the bone. Separate the parts of
the words, and think about what their
stems mean to help with locations.
42. 1. Ewing sarcoma is a bone tumor that
affects the shafts of long bones.
2. Pediatric bone sarcomas do not affect the
growth plate.
3. This is a specific location of a specific bone.
Ewing sarcoma can affect multiple bones.
4. The bone marrow is a site for hematological cancers.
TEST-TAKING HINT: It is important to be
familiar with the physiology of bones to
understand how bone sarcomas affect
them. Ewing sarcoma is a rare cancer that
affects a different part of the bone relative
to osteosarcoma.
43. 1. Chemotherapy can cause nausea,
vomiting, and possibly diarrhea, which
contribute to fluid volume deficit.
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2. Chemotherapy itself does not cause
chronic pain.
3. Radiation therapy has the potential for
skin impairment.
4. This is not an acute problem with
chemotherapy.
TEST-TAKING HINT: This is a general
question asking for basic side effects
of chemotherapy.
44. 1. Loose clothing helps reduce irritation
on the sensitive irradiated skin.
2. Emollients are contraindicated during
radiation because they can reflect the rays.
3. Irradiated skin is very sensitive to
extreme temperatures; a cold pack
could cause pain.
4. Hydrocortisone is not helpful for the
radiation-induced itching; it is for atopic
itching.
TEST-TAKING HINT: The test taker must
know what is most helpful for relieving
irritation as a result of what radiation
does to the skin. The question asks for
what to do during therapy.
45. 1. Bone grafts are not part of limb salvage.
2. Limb salvage requires the lengthening
procedures to encourage the bone to
continue to grow so the child will not
have a short limb.
3. This does not indicate understanding by
the parents.
4. Having a limb salvage does not mean the
child will never require chemotherapy as
part of the treatment.
TEST-TAKING HINT: A limb salvage means
the limb is saved, but that is not the end
of treatment for the child.
46. 1.2 mg. Change pounds to kilograms
(2.2 lb = 1 kg: 65/2.2 = 29.5 kg). Then
multiply kilograms by the dose of
0.04 mg/kg: 29.5 × 0.04 = 1.18 mg or
round to 1.2 mg.
TEST-TAKING HINT: Divide 65 lb by 2.2 to
determine kilograms.
47. 1. Striated muscle is in many organs and
sites of the body, thus leading to the multiple sites of the disease.
2. Striated muscle is in many organs and
sites of the body, thus leading to the
multiple sites of the disease.
3. Striated muscle is in many organs and
sites of the body, thus leading to the
multiple sites of the disease.
4. There is no such muscle.
TEST-TAKING HINT: The test taker must
understand the basic locations for each
muscle listed.
48. 1. This is stage I disease.
2. This is stage II disease.
3. Stage IV disease means there is distant
metastatic disease.
4. Lymph node involvement is not used as
part of staging for rhabdomyosarcoma.
TEST-TAKING HINT: The test taker must be
familiar with the basic staging of cancers.
49. 1. Metastatic disease is confirmed by a combination of tests.
2. A biopsy removes only a small piece of
the tumor.
3. A biopsy confirms the histology of the
tumor.
4. Chemotherapy, radiation, and surgery are
required for treatment.
TEST-TAKING HINT: A biopsy is used to get
the basic information of any solid cancer.
Additional tests and procedures are part of
treatment and more extensive diagnosis.
50. 1. Diarrhea can be a side effect of
chemotherapy, but it is not usually life
threatening.
2. Fever indicates infection that can be
life threatening after a bone marrow
transplant.
3. Skin breakdown is usually not life threatening.
4. Skin shrinkage is expected with treatment,
but it is not life threatening.
TEST-TAKING HINT: The test taker must
understand what a bone marrow transplant
involves and how bone marrow suppression can have life-threatening effects.
51. 1, 2, 5.
1. Pain occurs due to pressure on the
organs in the lower abdomen.
2. A retroperitoneal tumor affects the
organs of the lower abdomen, including the bowel and bladder.
3. A retroperitoneal tumor affects the organs
of the lower abdomen, including the
bowel and bladder. This tumor does not
affect the lungs.
4. There is no indication the child cannot
administer self-help.
5. Because this tumor is in the lower
abdomen, it puts pressure on the
bowel causing constipation.
TEST-TAKING HINT: The test taker must
understand the areas of the body. Having
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PEDIATRIC SUCCESS
an idea of the organs involved will indicate possible problems that can arise
when a tumor is in those locations.
52. 1. This is part of the normal breakdown and
buildup of bone in the body.
2. This is part of the process for
osteoarthritis.
3. This is the pathophysiology of calcium
chondrosis.
4. JIA is caused by an immune response
by the body on the joint spaces.
TEST-TAKING HINT: The test taker must
understand JIA is an immune-modulated
disorder and how the body attacks itself,
causing destruction of the joint spaces.
53. 1. Long-term corticosteroid use causes fat
deposits, especially in the back, face, and
trunk.
2. With the use of corticosteroids, there is
adrenal suppression because the exogenous steroid causes the body to lower
production of its own steroids.
3. Steroids cause immune suppression,
which is the reason behind its use in
JIA; it reduces the body’s attack on
itself.
4. Steroids cause hyperglycemia.
TEST-TAKING HINT: The test taker must
understand how immune system diseases
work in order to know how treatments
will be helpful. Consider how steroids
work and their complications. Each answer listed, except the correct answer, is
the opposite of the true side effects.
54. 1. NSAIDs can cause gastric bleeding
with long-term use; food helps to
reduce the exposure of the drug on
the stomach lining.
2. NSAIDs can cause gastric bleeding with
long-term use; food helps to reduce the
exposure of the drug on the stomach
lining.
3. NSAIDs do not require a blood level
because they are available over the counter.
4. NSAIDs do not interfere with the oral
cavity; however, other medications used
for JRA cause oral ulcers.
TEST-TAKING HINT: The test taker must
know what NSAIDs are and that they are
available over the counter.
55. 1. JIA is not a type of cancer.
2. These drugs affect the immune system
to reduce its ability to attack itself, as
in the case of JIA.
3. These medications are not the same as
NSAIDs.
4. They are not absorbed into the synovial
fluid to treat JIA; they suppress the
immune system.
TEST-TAKING HINT: There are some drugs
that are used for other reasons outside of
their usual use, such as chemotherapeutic
agents. Many drugs have multiple uses.
56. 1, 2, 5.
1. Providing pain medication prior to
ambulation helps decrease pain during
ambulation.
2. Children with JIA need to do rangeof-motion exercises to prevent joint
stiffness.
3. A high-fat diet is not helpful for mobility.
4. Oxygen is usually not necessary with the
diagnosis of JIA.
5. Using nonpharmacological methods
such as heat helps with flexibility and
pain.
TEST-TAKING HINT: By understanding the
disease process of JIA, the test taker will
know what interventions are needed to
help alleviate pain and disability.
57. 1. SLE is a complex disease; there are
many triggers, but how the disease
develops is not known.
2. There is some correlation with family
history.
3. There are multiple triggers for SLE,
including prescription drugs.
4. Antibodies have nothing to do with SLE
outcome.
TEST-TAKING HINT: Not all diseases have a
known cause.
58. 1. This is not a clinical manifestation.
2. The “butterfly,” or malar, rash is the
most common manifestation of SLE.
3. Weight loss, not weight gain, is a symptom of SLE.
4. Heart failure is not a common manifestation, but it can occur after long-term
disease that affects the heart muscle.
TEST-TAKING HINT: By understanding the
pathophysiology of SLE, the test taker
will be able to find the correct answer.
59. 1. Sun-protective clothing is important,
including hats.
2. Sunscreen helps reduce accelerated
burning due to sensitivity.
3. Participating in sports is important for
normalcy and should be encouraged.
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4. Protection from uncovered fluorescent
lights is as important as protection from
ultraviolet A and B light.
TEST-TAKING HINT: In general, sunscreen
is important for every question regarding
sun exposure and photosensitivity.
60. 1. For renal impairment due to SLE, monitoring the child’s weight is important but
checking the urine is a priority.
2. Uric salts are a normal concentrate of
urine.
3. Hypertension is a problem with renal
involvement, not hypotension.
4. Protein in urine is a sign of renal impairment, even in nephrotic syndrome, in
which the kidneys are losing protein.
TEST-TAKING HINT: The test taker must
understand what can happen to the body
when organs, such as the kidneys, fail.
61. 2, 3, 4.
1. Ortho Tri-Cyclen contains estrogen;
therefore, it is contraindicated.
2. Depo-Provera is progesterone, the
only contraceptive that is approved
for use in sexually active women
with SLE.
3. Abstinence is always recommended to
prevent pregnancy.
4. Condoms are always recommended.
5. Ortho Evra (“the patch”) contains estrogen and is therefore not recommended.
TEST-TAKING HINT: The test taker must be
familiar with the types of contraceptives
and with which contain combination hormones versus progesterone only.
62. 1, 2, 4.
1. Edema, numbness or tingling, and
pain are early signs of compartment
syndrome.
2. Edema, numbness or tingling, and
pain are early signs of compartment
syndrome.
3. Edema, numbness or tingling, and pain
are early signs of compartment syndrome.
4. A weak pulse is a late sign of compartment syndrome.
5. There is no rash with early compartment
syndrome.
TEST-TAKING HINT: The test taker can
eliminate answers 3 and 5 because severe
pain and rash are not signs of early compartment syndrome.
63. 1, 2, 4, 5.
1. In a recent fracture, the nurse should
assess pain and provide treatment.
2. Pain, pallor, and weak or absent pulses
are all signs of compartment syndrome.
3. Elevating the extremity is important
to decrease edema prior to the onset of
compartment syndrome. However, once
compartment syndrome is suspected,
the extremity should be kept at the level
of the heart to facilitate arterial and
venous flow.
4. Weak or absent pulse is a sign of compartment syndrome, so monitoring
capillary refill is important in assessment.
5. Pain, pallor, and weak or absent pulses
are signs of compartment syndrome.
Pain should be treated.
TEST-TAKING HINT: The test taker can
eliminate answer 3 because it is important to keep the affected extremity at
heart level to help arterial and venous
blood flow.
64. 1. It is a fracture that does not go all the way
through the bone.
2. It is a fracture that does not go all the way
through the bone.
3. It is a fracture that does not go all the way
through the bone.
4. It is a fracture that does not go all the
way through the bone.
TEST-TAKING HINT: The test taker must
know the definition of a greenstick fracture.
65. 1. Fractures of the growth plate are serious, as they can disrupt the growth
process.
2. Long-term follow-up is usually needed to
evaluate limb discrepancies and potential
joint abnormalities.
3. The ability to participate in contact sports
depends on many potential complications.
4. The amount of pain medication needed in
all fractures is determined by the patient.
TEST-TAKING HINT: The test taker must
know what determines how much pain
medication is needed.
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Leadership and
Management
13
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Advocacy
Assent
Confidentiality
Delegation
Ethical principles
Followership
Informed consent
Leadership
Malpractice
Management
Mentor
Nurse practice act
Priority
Risk management
Scope of practice
ABBREVIATIONS
Activities of daily living (ADLs)
Against medical advice (AMA)
Cardiopulmonary resuscitation (CPR)
Emergency department (ED)
Gastrointestinal (GI)
Glycosylated hemoglobin (HgA1C)
Health Insurance Portability and
Accountability Act (HIPAA)
Health maintenance organization (HMO)
Licensed practical nurse (LPN)
Licensed vocational nurse (LVN)
Peripherally inserted central catheter
(PICC)
Prothrombin time (PT)
Registered nurse (RN)
Respiratory rate (RR)
QUESTIONS
1. A 16-year-old is hospitalized for treatment of gunshot wounds acquired in a gang conflict. The teen often shouts at the nurses and uses vulgar language. Which activity is
the best example of patient advocacy?
1. Accepting the rude behavior without comment.
2. Avoiding entering the room except for scheduled treatments.
3. Meeting all demands in order to achieve peace.
4. Asking the teen to describe any fears about current treatment.
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PEDIATRIC SUCCESS
2. A 17-year-old is seen in the ED and diagnosed with a bowel obstruction. Despite the
nurse’s best attempt to explain the reason for a nasogastric (NG) tube, the adolescent
refuses to let the nurse insert the tube. The parent’s approach is also ineffective.
Which would be most appropriate for the nurse to do first?
1. Obtain an order for sedation, physically restrain the patient, and insert the tube.
2. Page the physician and document the patient’s refusal to accept the nasogastric tube.
3. Explain the against-medical-advice (AMA) form to the adolescent and parent.
4. Notify the hospital’s patient advocate to meet with the adolescent and parent.
3. An infant returned from GI surgery 4 hours ago. The parent refuses pain medication
for the baby and states, “The baby is crying because of hunger. Can I offer a bottle?”
How should the nurse best advocate for the infant?
1. Review the results of the observational pain scale with the parent, and explain why
the infant must have nothing by mouth.
2. Use nonpharmacological measures first to see if the pain rating of 8 (out of 10)
decreases.
3. Ask the parent to use the observational pain tool to measure the infant’s pain.
4. Call the physician to obtain an order to feed the infant.
4. At lunch, several nurses are discussing how difficult it is to care for a 16-year-old who
constantly complains of pain unrelieved by morphine via a patient-controlled analgesia
(PCA) pump. One nurse comments, “The teen is addicted to drugs. What do you expect?!” Which is the best response to this statement?
1. “The teen should be moved to an adult unit, where the teen will be told what to do.”
2. “We should make sure that the teen has a nursing student to give the staff some
relief.”
3. “Perhaps we should call a team conference to review the pain complaints and
treatment.”
4. “I think we should speak with the physician about changing to non-narcotic pain
medications.”
5. A case manager works in an outpatient clinic that administers palivizumab (Synagis) to
premature infants at high risk for respiratory syncytial virus. Which outcome is most
significant as an indication of effective treatment?
1. Prevention of hospitalization.
2. Optimum weight gain.
3. Promotion of parent-infant bonding.
4. Early detection and treatment of congenital defects.
6. A case manager is called to arrange for medical equipment and medications at discharge
for a child with multiple social problems. Which problem is likely to have the greatest
impact on discharge planning?
1. The child and family are homeless.
2. The child is not covered by insurance.
3. The family cannot pay for medications.
4. The child does not have a primary care provider.
7. Which outcome would indicate effective case management for a child with moderate
to severe asthma?
1. The child attends school regularly with few absences for the year.
2. The child is able to tolerate a regular diet without constipation or diarrhea.
3. The family does not fill prescriptions for prophylactic inhaled steroids.
4. The child does not utilize the peak flowmeter when cared for at home.
8. Which of the following is a component of family-centered care?
1. Reinforce all parenting practices.
2. Accept all cultural practices and rituals.
3. Guarantee that financial needs are met.
4. Recognize family strengths.
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9. Nurses are aware that current trends affecting health-care consumers include which
of the following? Consumers:
1. Generally are less informed about health-care issues than previous generations.
2. Are comfortable with health insurance benefits, services, and conditions.
3. Are more trusting and less demanding of health-care organizations and staff.
4. Expect to be more involved in decisions about health-care options.
10. A child and family are addressed by the nurse during admission to the pediatric unit.
Which statement is the best example of a proactive service orientation?
1. “Do you have any special questions or concerns that I can address?”
2. “It is important that you keep the crib side rails up at all times you are not at the
bedside.”
3. “We ask that you restrict visitors to two persons at the bedside due to space
limitations.”
4. “Because your child is on contact precautions, your child will have to remain in
the room.”
11. A seriously ill child is treated in the intensive care unit. Which aspect of care is the
easiest for family members to evaluate and most important for consumer satisfaction?
1. The compliance with standards.
2. The efficiency of the medical equipment used in care.
3. The relationship with the nurse and other staff.
4. The accuracy of completion of medical orders.
12. An interdisciplinary team is assembled to review protocols for management of central
intravenous lines. Which staff should be represented on the team?
1. Experienced RNs and pharmacists.
2. RNs, physicians, and pharmacists.
3. RNs, LPNs/LVNs, and physicians.
4. Charge nurses and staff physicians.
13. The staff nurse is discharging an infant with a tracheostomy and gastrostomy to be
cared for at home. The case manager has arranged for home health supplies and
services. Whose discussion would be of most direct benefit to ensure individualized
care in the home?
1. Case manager and community pediatrician.
2. Case manager and home health company supervisor.
3. Staff RN and medical supply company.
4. Hospital staff nurse and home health nurse.
14. An experienced nurse notes that a child is developing a rash shortly after the first
dose of an intravenous antibiotic. Which team member should be called first?
1. Physician.
2. Pharmacist.
3. Charge nurse.
4. Unit manager.
15. It is a busy day on the pediatric unit, and the nurses are short-staffed. A school-aged
child is scheduled to undergo an invasive radiologic procedure. Which staff member
would be most appropriate to meet the child’s support needs by accompanying the
child to the radiology department?
1. The staff nurse with the least busy assignment.
2. The staff nurse assigned to this child.
3. A volunteer grandparent who is on the unit.
4. The child life–worker for the unit.
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16. Which activity, encouraged by the management, would be most effective in helping a
new nurse manager develop transformational leadership abilities in a rapidly changing practice setting?
1. Select a mentor and a professional support group.
2. Focus on activities that avoid change and involve minimal risk.
3. Reward or correct followers to maintain current levels of practice.
4. Use your own judgment when making decisions, with little input from staff.
17. Which activity best falls within the scope of management rather than leadership?
1. Planning the staffing schedule for a 2-month period.
2. Empowering the staff to meet patient-care goals for the year.
3. Encouraging staff to utilize reflective practice and self-awareness.
4. Inspiring staff to develop a shared vision of quality patient care.
18. Tasks of followership that would be expected of a new nursing graduate include
which of the following?
1. Collaborates with others, honors standards, demonstrates individual accountability.
2. Envisions organizational goals, affirms values, represents the group.
3. Motivates others, develops standards, eliminates barriers to care.
4. Evaluates system processes, recommends ways to improve the system.
19. The pediatric unit is re-evaluating the procedure used by staff to suction tracheostomies.
Which activity demonstrates followership activities appropriate to a recent nursing
graduate?
1. Rewrite the hospital policy and procedure for tracheostomy suctioning.
2. Work with information technology to plan new computer screens for charting.
3. Provide input on the feasibility and effectiveness of the new procedure.
4. Hold in-services to educate staff on the techniques and rationale for the new
procedure.
20. The nurse receives a telephone call from a staff member who works on another unit.
The member is inquiring about the test results of a friend’s child, who is hospitalized
on the nurse’s unit. Which response is appropriate?
1. Summarize the test results, as they are within the normal range.
2. Move to a private phone to prevent being overheard before sharing the information.
3. Decline to give out information.
4. Direct the staff member to the test results in the hospital electronic medical
record.
21. A pediatric hospital nurse receives a telephone call from an individual who is the parent of a child assigned to the nurse’s care. Which action by the nurse is most correct?
1. Verify the privacy code assigned to the child before giving any information.
2. Decline to give out information over the telephone because no ID can be shown.
3. Update the parent on the child’s condition, as no family members are in the room.
4. Take the parent’s name and telephone number and give it to the other parent
when visiting.
22. A nursing student records notes about a pediatric patient’s condition in preparation
for a clinical experience. Which information is considered individually identifiable
health-care information and cannot be attached to the notes?
1. Date of birth.
2. Medical diagnosis.
3. Nursing diagnosis.
4. Diagnostic test results.
23. If an employee has medical testing at a facility where that employee works, what is
the appropriate way to access the test results?
1. Complete the authorization form and receive a copy of the results.
2. Get a fellow employee who works in that department to access the results.
3. Call a friend who has access to the records and ask for a copy of the test results.
4. Check the computer system for the test results.
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24. For a school-aged child who has Kawasaki disease and is taking aspirin, which laboratory value should be reported to the physician?
1. Blood, urea, nitrogen 18 mg/dL.
2. Hematocrit 42%.
3. Potassium 3.8 mEq/L.
4. PT 14.6 sec.
25. During a home visit to an 8-month-old infant in congestive heart failure on digoxin
(Lanoxin), the nurse obtains assessment information. Which assessment indicates
that the nurse needs to consult the physician?
1. The infant’s apical pulse is 70 at rest.
2. After crying, the infant’s heart rate is 170.
3. Respirations are 40 per minute at rest.
4. Capillary refill is <3 sec.
26. A premature infant with chronic lung disease is going home with complex care, including oxygen, tracheostomy suction, and gastrostomy feedings. Which discharge
planning activity will be most effective in promoting continuity of care?
1. Send the parents to meet staff at the nursing agency that will be providing care in
the home.
2. Plan a team conference at the hospital before discharge to include parents and
hospital and home health staff.
3. Ask the parents to meet with the hospital respiratory therapy staff to discuss
adapting the home environment to meet equipment needs.
4. Teach parents how to care for the child by utilizing hospital equipment and
protocols.
27. Which patient can benefit most by a primary nursing approach in which one nurse
cares for the child whenever on duty and coordinates other staff care?
1. A child admitted for a diagnostic workup of mononucleosis.
2. A child who had surgery 1 day ago for appendicitis.
3. An infant treated with phototherapy for hyperbilirubinemia.
4. A toddler with leukemia, admitted for chemotherapy.
28. When caring for an infant admitted for pyloric stenosis surgery, which tasks would
be appropriate for the RN to delegate to a nursing assistant? Select all that apply.
1. Physical assessment on admission.
2. Vital signs every 4 hours.
3. Discharge teaching for parents.
4. Bed, bath, and change of linens.
5. Daily weights.
29. The nurse is managing care of a school-aged child with new-onset type 1 diabetes.
Which tasks must be performed only by the RN and cannot be delegated to an
LPN/LVN or nursing assistant? Select all that apply.
1. Teaching parents how to give subcutaneous injections of insulin.
2. Performing blood glucose monitoring before meals and bedtime.
3. Evaluating the child’s response to insulin doses.
4. Determining the educational goals for the day.
5. Teaching the child signs for hypoglycemia and hyperglycemia.
30. Assigning the right task to the right person is a principle of nursing delegation and
assignment. Which scenario best meets this principle?
1. A 4-month-old with Down syndrome is assigned to a nurse whose own child died
of heart disease due to Down syndrome 6 months ago.
2. A child with a central intravenous line that occluded on the previous shift is
assigned to a new LPN/LVN.
3. A child newly diagnosed with acute leukemia is assigned to an experienced pediatric
oncology nurse who floated to the general pediatric unit.
4. A child with new-onset type 1 diabetes is assigned to an RN who has four other
complex-care patients.
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31. An experienced pediatric nurse relocates to a new city and state. In the new position,
the nurse questions which skills and tasks can be performed by unlicensed nursing
personnel. To obtain answers to this question, which resource is considered primary?
1. Hospital policies and procedures manual.
2. State nurses’ association.
3. Educational program for nursing assistants.
4. State nurse practice act.
32. When caring for a patient in pain, which activity is appropriate to delegate to unlicensed nursing personnel?
1. Coaching the patient during painful procedures.
2. Assessment using a self-report pain scale.
3. Evaluating pain after giving medication.
4. Bathing the patient and hygiene measures.
33. After receiving the change-of-shift report, the nurse prioritizes care for the day.
Which child should the nurse assess first?
1. 1-month-old admitted 1 day ago with fever and possible sepsis.
2. 14-month-old with a tracheostomy admitted for respiratory syncytial virus (RSV)
bronchiolitis.
3. 18-month-old with acute viral meningitis.
4. 7-year-old 1 day after an appendectomy.
34. After a school bus accident, four elementary school children are delivered by ambulance to the emergency department (ED). Which child should be directed to the
physician first by the triage nurse?
1. The child who is crying uncontrollably and tries to move off the stretcher.
2. The child with severe abdominal pain, who is anxious and responsive, and whose
blood pressure is 100/60; heart rate is 120; and respiratory rate is 28.
3. The child with severe pain and distorted alignment of the right lower leg, indicating a possible fracture.
4. The child who is unresponsive, with fixed and dilated pupils, blood pressure
58/44; heart rate 60; RR 10.
35. The nurse is providing care for an adolescent with complex needs after surgical correction of a severe bowel obstruction. On entering the room, the nurse prioritizes
care and decides to complete which task first?
1. Change the central intravenous line dressing, which is loose and gaping.
2. Empty the ileostomy bag, which is moderately full of liquid stool.
3. Change the gauze dressing around the Jackson Pratt drain.
4. Check for correct positioning of the nasogastric (NG) tube in the stomach.
36. An adolescent is received in the pediatric intensive care unit after scoliosis surgery.
Using Maslow’s Hierarchy of Needs as a guide, which problem takes priority?
1. Hypotension related to analgesia.
2. Fear of being left alone by parents.
3. Frustration with post-operative immobility.
4. Concern with the extensive skin incision.
37. A child is receiving continuous morphine by patient-controlled analgesia (PCA)
pump (basal and bolus) to control pain. Which side effect is the nurse’s greatest
concern?
1. Sedation.
2. Respiratory depression.
3. Nausea and vomiting.
4. Constipation.
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38. Which question represents an ethical issue in nursing practice that cannot be resolved through clinical research?
1. How does the incidence of medication errors on the pediatric unit compare with
the incidence of errors on the neonatal unit?
2. Does the use of local anesthesia during circumcision make a difference in infants’
pain scores, as measured on the face, legs, activity, cry, consolability (FLACC)
scale?
3. Is the emergency room nurse obligated to report suspicion of child abuse if signs
of abuse are noted in the assessment?
4. Which method of irrigating central venous lines results in less line obstruction
and infection?
39. Shortly before a child’s elective surgery, the parent tells the nurse, “I am having second thoughts about my child undergoing this surgery.” The nurse respects the parent’s concern and calls the surgeon. What ethical/moral principle is represented by
this situation?
1. Autonomy.
2. Equality.
3. Fidelity.
4. Justice.
40. During a clinic visit, a child’s mother tells the nurse, “I’m afraid of what my husband
will do.” Following an ethical decision-making process, the nurse’s first step is to:
1. Direct the mother to a center for abused women.
2. Provide the phone number of the domestic violence hotline.
3. Clarify what the mother means by her statement.
4. Ask the mother, “Why does your husband feel this way?”
41. Which situation would be appropriate to refer to the hospital ethics committee?
1. The physician recommends that a young child in the end stages of terminal cancer
be taken off the ventilator. The parents, who are divorced and have joint custody
of the child, have different views about whether to discontinue the ventilator.
2. A child in end-stage renal failure is placed on the renal transplant list. The parents are asked to sign permission for surgery after a cadaver kidney is located.
One parent is out of town and gives telephone consent.
3. After initial therapies have failed, a child with leukemia is evaluated for a new cancer protocol. The child, age 8 years, gives assent for the new treatment, and his
parents give consent as well.
4. Parents are shocked when their child is diagnosed with a malignant bone tumor.
The orthopedic surgeon discusses the options of limb amputation and a limbsalvage procedure. The parents are asked to consider each option.
42. Organizational policies on the security of computer data mandate that system users
keep which piece of user information confidential?
1. Name.
2. ID.
3. Password.
4. Credentials.
43. The nurse is charting on the computer at the nursing station when a parent exits a
nearby room and asks for help because the child has vomited. Which immediate
action is best?
1. Immediately assist the parent.
2. Put the computer in “suspend mode” so that the screen is blank and then assist
the parent.
3. Finish recording information and exit out of the computer before assisting the
parent.
4. Continue charting and call another team member to assist the parent.
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44. If a staff member has the right to access the computer system, the member has a
right to view which health records?
1. Personal.
2. Immediate family members.
3. Patients assigned to their care.
4. Patients’ family members.
45. Individually identifiable health information may not be:
1. Faxed.
2. Mailed.
3. Copied.
4. Sold.
46. Which patient is able to give informed consent for a surgical procedure in many U.S.
states?
1. 13-year-old abused male.
2. 15-year-old pregnant female.
3. 16-year-old cancer patient.
4. 17-year-old college freshman.
47. Which of the following situations would be considered failure to obtain informed
consent?
1. Parents who speak Spanish receive information about their child’s surgery from
the surgeon using a telephone language-line Spanish translator.
2. Bilingual parents sign the consent form for a lumbar puncture. Later, they tell a
Spanish-speaking nurse, “We do not understand why they are doing this test.”
3. The physician addresses the benefits of a procedure with a child’s parents but gets
called away. Later, the physician returns to finish the discussion before parents
sign the consent.
4. Only one parent of a child is present in the hospital to sign the surgical consent.
The other parent is out of town on business.
48. Staff members working with school-aged children believe it is important for each
child to understand and agree to medical treatment, especially when treatment is part
of research protocols. The term for this process is:
1. Assent.
2. Informed consent.
3. Confidentiality.
4. Emancipation.
49. When explaining the procedure to the parent of a child undergoing surgery, the
provider must give the following information as part of informed consent. Select all
that apply.
1. Date and time the specific procedure will be performed.
2. Alternative therapies.
3. Benefits that are likely to result from the procedure.
4. Names and titles of all staff members who will be in the operating room.
5. The patient and family may withdraw consent at any time.
50. When making assignments for the oncoming shift on the pediatric unit, the charge
nurse assigns a float RN from another unit to care for an infant with complex needs.
What is the legal responsibility of the charge nurse in this situation?
1. Assurance of scope of practice.
2. Duty to orient, educate, and evaluate.
3. Patient’s rights and responsibilities.
4. Determination of nurse/patient ratios.
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51. After the parent leaves the side rail down, a hospitalized toddler falls from the crib
and suffers a skull fracture. Earlier that day, the nurse had discussed the importance
of side rails with that parent and recorded the discussion in the nursing notes. Which
element of malpractice is missing in this case?
1. Relationship with the patient.
2. Breach of duty of care.
3. Injury.
4. Damage.
52. The nurse should check the agency’s policy and procedure manual as the primary
legal authority for which of the following?
1. Whether an RN can initiate a blood transfusion.
2. Sharing of patient-sensitive information.
3. Legal protection when providing CPR to a non-patient.
4. Procedure for flushing a central venous line.
53. Which situation might be considered assault and battery of a child?
1. The nurse sticks a hysterical infant five times in an attempt to start a PICC line,
although the parent verbally refuses to allow the procedure to continue after the
third try.
2. A 2-year-old screams while being restrained for a dressing change of a complex
burn wound.
3. A nurse attempts to administer an oral antibiotic to a young child who then spits
the entire dose of medication out on the sheet.
4. A post-operative school-aged child refuses when told to get out of bed and walk in
the hall four times a day.
54. The nurse makes an error by giving the wrong medication to a patient. An incident
report is completed per hospital policy. What information should the nurse chart in
the medical record?
1. Description of the specific occurrence and treatment given.
2. Completion of the incident report.
3. Date, time, and name of person completing the incident report.
4. Nothing.
55. Which event should be reported to a risk management committee by documentation?
1. A nurse administered a double therapeutic dose of medication based on an incorrect physician order.
2. A patient’s heparin lock became clotted between intermittent medication doses.
3. A toddler dislodged the intravenous catheter, resulting in an occluded intravenous
line.
4. An uncooperative child spit out an undeterminable amount of oral medication
despite the nurse’s best effort.
56. Which event represents a departure from safe practice as defined by risk management?
1. A nurse double-checks an insulin dose with a nursing assistant before administration to the patient.
2. The physician writes an illegible order, then draws a line through it, initials it, and
prints the same information above the line.
3. The nurse repeats a verbal order back to the physician and asks for verification of
accuracy.
4. A nurse asks another RN to double-check a dose of morphine before administering the drug via intravenous push.
57. The diabetes clinic conducts a disease management program for children with type 1
diabetes. Which test is the most valid indicator of compliance with the diabetes
regimen?
1. Fasting blood glucose level.
2. Fingerstick glucose for 24 hours.
3. Urine ketone strip.
4. HgA1C assay.
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58. A charge nurse overhears a staff nurse make an erroneous statement to a parent in
the hallway. What should the charge nurse do first?
1. Discuss the correct information with the parent.
2. Discuss the observation with the manager of the unit.
3. Write a description of the incident and share it with the staff nurse.
4. Ask the staff nurse to describe the situation in private.
59. Which situation should be referred by the pediatric nursing staff to the nurse manager?
1. Several staff members plan to get together to celebrate the end of a successful
year working on the unit.
2. Staff members complain about the cafeteria food and want a broader menu.
3. Patients with occluded saline locks are repeatedly being transferred from the
emergency department to the pediatric unit.
4. Nursing staff members who have joined the union are in disagreement with union
policies.
60. A 9-year-old patient on the pediatric unit is immobilized in a spica cast. When the
parents are absent, the child presses the call light constantly. Which action would be
most appropriate to meet the child’s needs?
1. Consult with the charge nurse to obtain a 24-hour sitter for the child.
2. Speak with the parents and ask them not to leave the bedside.
3. Refer to the child life–worker for bedside play activities.
4. Obtain a social service referral to meet emotional needs.
61. A young child hospitalized with asthma is ready for discharge. A home nebulizer is
ordered by the physician. In order to obtain the nebulizer, a referral should be made
to which staff member?
1. Case manager.
2. Nurse manager.
3. Materials management staff.
4. Child life staff.
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The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Acceptance of the teen’s humanity does not
mean acceptance of inappropriate or rude
behavior. The nurse also has rights and
should communicate to the teen how the
behavior is being interpreted.
2. Avoidance of the teen is likely to further
alienate and isolate the teen, increasing
fears and concerns.
3. Meeting all demands may not be appropriate in this situation. Nursing staff members
need to negotiate, clarify, and explain which
behaviors are acceptable, without reinforcing negative behavior.
4. All patients have the right to be informed
and participate in care decisions. Assessment of needs is the first step in providing
culturally congruent care and education.
TEST-TAKING HINT: Patient advocacy is
based on protecting the basic rights of
patients in the health-care system. Understanding the disease process and its treatment is one of these rights. As in all aspects of care, assessment of the patient’s
questions and fears is the beginning of
patient education.
2. 1. This approach involves little advocacy for
the patient, because it bypasses rather than
supports self-determination.
2. This approach would be used only after
other methods to communicate with the
patient have been attempted.
3. This is the least effective approach, because
if the adolescent leaves against medical advice, no care will be received.
4. Because of the patient’s age, the teen
should be treated as an adult. The nurse
best promotes self-determination by
making additional attempts to elicit any
fears and concerns that are preventing
effective care. The patient advocate may
be able to gain this information.
TEST-TAKING HINT: Patient advocacy includes promoting the rights of the patient,
in this case the right to self-determination
and informed consent. Utilizing the patient
advocate in this situation is an effective way
to further determine why the patient is
refusing care.
3. 1. As the advocate for the infant and parent, the nurse has the responsibility to
educate the parent about the infant’s
condition after surgery, the rationale for
having nothing by mouth, and the assessment and treatment of pain. By
being informed, the parent can make
educated assessments and decisions, collaborating with the nurse to meet the
infant’s needs.
2. A pain rating of 8 indicates severe pain and
the need for pharmacological and nonpharmacological pain control measures.
3. Although the parent should be educated
about the pain tool, the parent should not
be accountable to use the tool to measure
the infant’s pain.
4. If the infant had major GI surgery, it would
be contraindicated to feed the infant immediately post-operatively.
TEST-TAKING HINT: Advocacy helps to
ensure that pain and other post-operative
needs are met by nursing staff. Because
parents have the legal authority to consent
for their child’s treatment, it is critical that
they be fully informed and understand the
child’s post-operative status and rationale
for treatment.
4. 1. Passing responsibility for care to another
unit where staff do not know the teen is
unlikely to resolve problems with care.
2. Recruiting a student who is less experienced
in the care of complex pain patients is unlikely to resolve problems with care.
3. As a patient advocate, the nurse is responsible for recognizing when current
approaches are ineffective and working
with other staff members to develop effective care. Planning a team conference
is one way to brainstorm new approaches.
4. If morphine does not relieve the pain, this
answer is unlikely to be effective.
TEST-TAKING HINT: As a patient advocate,
the nurse promotes the rights of this
patient to optimum treatment and pain
relief. Because pain is a complex phenomenon, a multidisciplinary approach is often
helpful to come up with new and more
effective approaches.
5. 1. Palivizumab (Synagis) is an antibody administered monthly to premature and
other high-risk infants during respiratory
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syncytial virus (RSV) season. The goal
is prevention of serious respiratory
syncytial virus bronchiolitis requiring
hospitalization.
2. Although weight gain is an important
health outcome for rapidly growing premature infants, it is not the focus of a clinic for
respiratory syncytial virus prophylaxis.
3. Promotion of parent-infant bonding is a
goal for nurses working with infants; however, this is not the focus of a clinic for respiratory syncytial virus prevention.
4. Early detection and treatment of congenital
problems is important for the health of
premature infants, but it is not the focus
of a clinic for respiratory syncytial virus
prevention.
TEST-TAKING HINT: Because of the expense
and special authorization needed from
third-party payers, palivizumab (Synagis)
is often administered in specialty clinics.
Case managers work with clinic patients
to coordinate care, promote cost savings,
use resources efficiently, and improve
patient outcomes.
6. 1. Homelessness is likely to have the
greatest impact on discharge planning
because all other aspects of care revolve
around this issue.
2. The social worker can assist the family in
applying for medical aid due to low income.
3. Discharge medications can often be secured
through the assistance of the social worker
and hospital pharmacy.
4. The child can be referred to a clinic that
works with indigent patients for follow-up
and continued care.
TEST-TAKING HINT: Homelessness affects all
other issues and requires social services in
both the community and hospital.
7. 1. Regular school attendance is a positive
outcome of case management because
asthma can result in frequent absences
from school.
2. Diet is rarely a problem in asthma and
would not be an indication of compliance
with care.
3. This situation is considered a negative outcome, because children with moderate or
severe asthma need inhaled steroids to
decrease lung inflammation.
4. This situation is a negative outcome. Peak
flowmeters should be used to monitor lung
function and guide treatment decisions.
TEST-TAKING HINT: The goal of case management in asthma is improved health
outcomes, including prevention of exacerbations of illness. School attendance, prevention of hospital admissions, regular
checkups, early diagnosis of illness, and
compliance with medications are indicators
of effective case management.
8. 1. Parenting practices are respected as long
as children’s needs are met; however, this
may not be true of all parenting practices.
Parent education and negotiation may be
required.
2. There may be times that cultural practices directly conflict with medical treatments; therefore, acceptance is based on
compatibility.
3. Although financial support for families is
included in family-centered care guidelines, there is no guarantee that all financial needs will be met.
4. Recognizing and building on family
strengths is an important component
of family-centered care.
TEST-TAKING HINT: All pediatric health-care
organizations include family-centered care
as part of their patient rights documents.
Family-centered care includes recognizing
the family as the constant in the child’s life,
creating parent-professional collaboration,
encouraging parent-to-parent support, and
building on family strengths.
9. 1. Today’s health-care consumer is better educated, often from searching the Internet,
and expects to receive more information
from providers.
2. In contrast, many patients are dissatisfied
or confused about benefits under their
health insurance plans.
3. To the contrary, data show that patients
are more demanding and aggressive in situations involving health care.
4. Data show that current health-care
consumers expect to participate more
in decisions about medical treatment.
TEST-TAKING HINT: Consider the effect of
societal trends, such as Internet access,
advertising and marketing, increased
rights of women and minorities, changes
in insurance and HMOs, and increasing
diversity.
10. 1. This is a proactive statement with a
“ready to help” image.
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2. This statement provides information
about crib safety.
3. This statement provides information
about visiting policies.
4. This statement provides information
about isolation policies.
TEST-TAKING HINT: A service orientation
focuses on customer satisfaction. Proactive statements with a “ready to help”
image include such phrases as “How may
I help you?”, “I’d be happy to . . .,” and
“It’s my pleasure to . . ..”
11. 1. Consumers are frequently unable to judge
this aspect of care.
2. This is not a known aspect of care for
most family members.
3. Consumers always have the ability to
evaluate the quality of the relationship
with the person delivering the service.
4. Family members as consumers seldom
have the information to judge this aspect
of care.
TEST-TAKING HINT: Although consumers
are frequently unable to judge or evaluate
the quality of interventions, they always
have the ability to evaluate the quality of
the relationship with the person delivering
the service. Most consumer complaints revolve around problems with staff, such as
feeling ignored, disrespected, or being
treated poorly.
12. 1. The team should be composed of these
staff members; however, this answer omits
physicians, who write the orders for the
central intravenous line.
2. Because all three of these disciplines
are involved in care of central intravenous lines, this answer is the most
complete.
3. In many locations, LPNs/LVNs are not
authorized to care for central intravenous
lines and would not be involved in this
care. Furthermore, this answer omits
pharmacists, who are concerned with
medication administration through these
lines.
4. Involving only persons at the leadership
level may lead to omission of valuable input from staff RNs, resident physicians,
and other disciplines such as pharmacy.
TEST-TAKING HINT: Involving all team
members who have responsibilities related to this activity helps to ensure that
all important factors are considered.
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When members of all involved disciplines
participate in decision making, they are
more likely to agree to any changes made.
13. 1. These team members have oversight for
assessing, planning, and evaluating care of
the child but do not provide direct nursing care in the hospital or home.
2. Both of these team members are in managerial roles, which are essential for providing resources, but may not guarantee
an individualized approach to care.
3. Planning for home-care supplies is an important function but not as broad as that
provided by other team members.
4. If the goal is individualized care, the
best team members to discuss this
child’s care are the two staff members
with the most direct caretaking
responsibilities—the hospital staff
nurse and the home health nurse.
TEST-TAKING HINT: The key to deciding
among staff members is the phrase “individualized care.” Which two team members will be in most direct contact with
the child and family? These staff members are most likely to know the individual characteristics of the child and family
members.
14. 1. Development of an allergic reaction,
which is most likely happening in this
situation, requires prompt treatment
to prevent complications such as anaphylaxis. The physician should be
called first so that prompt treatment
can be ordered.
2. The pharmacist cannot change the drug
without a physician’s order.
3. Although the charge nurse should be informed in a timely manner, the nurse has
the responsibility to communicate directly
with the physician when an allergic reaction is suspected.
4. This incident may or may not require
communication to the unit manager.
TEST-TAKING HINT: Problem-solving requires knowledge of clearly delegated
roles and duties. Only the physician has
the authority to prescribe an antihistamine. Furthermore, the nurse has the
legal responsibility to notify the physician
of any complication, such as a rash.
15. 1. The child does not know that nurses have
other patient assignments and may not
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feel supported. Additionally, this arrangement takes the staff nurse away from assigned patients.
2. In a short-staffed situation, it may be
impossible to take a nurse off the floor
for even a short radiologic procedure.
Care of other assigned patients may be
compromised.
3. A volunteer may not be able to support
the child adequately in an unfamiliar situation and may have difficulty coping with
the stress of an intrusive procedure.
4. Helping children cope with intrusive
or frightening procedures is part of
the job description of the child
life–worker. This answer has the added
advantage of maintaining staff nurse
numbers on the unit.
TEST-TAKING HINT: The best answer considers the staffing needs of the unit as
well as the individual support needs of the
child. In answers 1 and 2, staffing may be
compromised by sending a nurse off the
unit. In answer 3, the volunteer may not
be able to support the child adequately.
Because support during intrusive procedures is a common function of the child
life–worker, answer 4 is most likely to
provide the child with maximum support
without reducing nursing staffing.
16. 1. A mentor can model new behavior
and coach the new nurse manager
while providing support during new
experiences.
2. The novice nurse leader-manager must be
willing to change, grow, and take risks.
3. Transformational leadership involves inspiring new visions rather than maintaining the status quo.
4. A good leader gathers input from all levels of staff when making decisions.
TEST-TAKING HINT: Transformational leadership is best in changing environments.
This leadership style involves creativity,
change, risk, shared vision, and attention
to the importance of people. The challenges of developing these leadership abilities are best met by the novice leadermanager who has the support of a mentor
who can serve as a coach, teacher, and resource person.
17. 1. Managers coordinate and utilize resources. Planning for staffing is an
example of both coordination and utilization of staff.
2. Empowerment of staff best fits within the
scope of leadership.
3. Encouraging self-reflection is a motivational activity included in leadership
theories.
4. Leaders help to transform organizations
through motivation and inspiration of
employees.
TEST-TAKING HINT: Management is defined
as a process of coordinating activities and
utilizing resources to achieve goals. Actions tend to be more specific, such as
preparing the staffing schedule. Leadership is a broader concept, involving staff
empowerment, system redesign, ethics,
and increased motivation.
18. 1. These followership activities are appropriate for a new graduate nurse.
2. These activities are leadership and management tasks, appropriate for the experienced practitioner.
3. These tasks fall within the scope of leadership and management.
4. These tasks require experience in an organization and are appropriate for leaders
and managers.
TEST-TAKING HINT: Bleich’s tasks of leadership, management, and followership are
included in the examples above. The new
nursing graduate would be expected to
demonstrate good followership before
taking on leadership and management
tasks.
19. 1. Writing policies and procedures is an
advanced activity, performed by nurse
managers.
2. Designing systems for charting is an advanced task, requiring experienced staff.
3. Testing a new procedure falls within
the scope of a new practitioner and is
an appropriate followership activity.
4. Staff educators are experienced staff
members whose responsibility is to plan
in-service education.
TEST-TAKING HINT: Because the new graduate focuses on followership tasks, the
key to answering this question is to determine whether actions fall within the scope
of leadership, management, or followership. Testing out a new procedure is most
clearly a followership task.
20. 1. Providing information to a staff member
who is not involved in the patient’s care is
a violation of privacy and must be avoided.
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2. It is a violation of privacy to share information with others without the
patient/family permission.
3. The pediatric nurse cannot legally
share this information, but the parent
can choose to do so. This response
does not violate the patient/family
right to privacy.
4. It is a clear violation of privacy to access
electronic medical records without a
need to know this information to provide
care. Because the staff member is not
involved in the child’s care, that person
cannot legally access the child’s medical
information.
TEST-TAKING HINT: Sharing clinical information is guided by the “need to know”
in order to care for a patient. In this case,
the staff member works on another unit
and is not caring for the friend’s child.
“Need to know” does not exist here.
21. 1. The nurse is correct to verify the privacy code, which is given only to the
child’s legal guardians, before relating
medical information over the telephone.
2. The nurse is incorrect to deny information to individuals who have a right to
know such information.
3. Failure to verify the caller’s right to receive information is a violation of the patient’s right to privacy and confidentiality.
4. The nurse is incorrect to deny information if the caller can provide proper ID.
TEST-TAKING HINT: Institutions can reduce
violation of a patient’s privacy and confidentiality by allowing access to patient
data only by individuals who are legally allowed to receive it. Most hospitals maintain privacy of data by assigning a privacy
code, which is given to immediate family
members, or maintaining a list of persons
who are allowed information. Verification
of a caller’s right to receive information
should be made by the nurse before giving out information over the telephone.
22. 1. Date of birth is information that can
be used to identify an individual and
should not be attached to students’
notes.
2. The medical diagnosis is not considered
individually identifiable information.
3. A nursing diagnosis is not considered individually identifiable information.
4. Diagnostic test results are not considered
individually identifiable information.
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TEST-TAKING HINT: Information that can
be used to identify an individual includes
name, birth date, Social Security number,
and medical record number. Attaching
this information to health-care data violates patient confidentiality and privacy.
23. 1. Employees who seek access to their
own medical records must follow the
same procedures as any patient treated
by the health-care facility.
2. This action violates federal laws regarding
protected health information, because the
employee does not have a “need to know”
to provide care.
3. This action constitutes a privacy violation,
because the friend does not have a “need
to know” to provide care.
4. Clinical information systems should be
accessed only as necessary to provide patient care. This does not include access to
personal records.
TEST-TAKING HINT: Federal guidelines require that all patients access their personal medical records following the same
procedures. The standard for accessing
patient information is a “need to know”
for the performance of the job.
24. 1. This value is in the normal range. Normal blood urea nitrogen is 10–20 mg/dL.
For a patient on aspirin, an elevated blood
urea nitrogen value might be a result of
chronic GI bleeding.
2. This value is in the normal range. Normal hematocrit values are 37–47 (females)
and 42–52 (males). Hematocrit values decrease if bleeding occurs.
3. This value is in the normal range. Normal potassium values are 3.5–5.0 mEq/L.
The nurse monitors for a decrease in
potassium.
4. This value indicates an increase in PT
and should be reported to the physician. Normal range is 11–12.5 seconds.
Prolonged bleeding time can be a side
effect of aspirin.
TEST-TAKING HINT: Two variables must be
considered when answering this question:
Which laboratory values are abnormal and
what changes are likely to be seen with
aspirin, due to the side effect of bleeding?
25. 1. Bradycardia (heart rate below
90–110 bpm in infants) is a common
sign of digoxin toxicity. The provider
should be notified.
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2. Increased heart rate after crying is a normal finding in an infant.
3. This is a normal RR in an infant. Tachypnea, a complication in congestive heart
failure, is usually defined as an RR greater
than 60–80 breaths per minute.
4. This is a normal capillary refill (<2–3 sec).
Delayed capillary refill is a sign of complications in congestive heart failure.
TEST-TAKING HINT: Digoxin is a potentially
dangerous drug because of the narrow
margin of safety between therapeutic and
toxic doses. Accidental overdose is possible because such small doses are given to
infants (usually less than 1 mL).
26. 1. This activity is appropriate but does less
than other answers to promote continuity
of care because it omits hospital staff.
2. By including parents, hospital staff,
and home-care staff, a joint team conference is the best option to promote
continuity of care.
3. Adaptation of the home environment is
important in the discharge process, but
it is not focused on the goal of continuity
of care.
4. Teaching parents how to care for the
child in the hospital is an important first
step to home care, but it does less than
other options to meet the goal of continuity of care.
TEST-TAKING HINT: The question focuses
on effective promotion of continuity of
care. Although other answers are important in planning for home care, only answer 2 involves all family and staff members, promoting continuity between
hospital and home.
27. 1. Primary nursing is less important in this
situation. This child is likely to have a
short hospital stay, without readmission.
2. Appendicitis, without complications, usually results in early discharge or a short
hospital stay. Continuity of staff is less
important.
3. The hospital treatment of hyperbilirubinemia is likely to be very short, because
this condition can also be treated in the
home. Primary nursing is less important.
4. This child is likely to be admitted for
repeated hospitalizations and over a
longer period of time than other patients. Having a close relationship with
one or a few nurses can lead to increased satisfaction for all.
TEST-TAKING HINT: The advantage of primary nursing is continuity in the relationship between the child/family and the
nurse. A more individualized approach
can be provided, leading to more holistic
care. This approach is most valuable for
patients with repeat hospitalizations and
longer stay.
28. 2, 4, 5.
1. RNs should perform all admission assessments. By law, this function cannot be
delegated.
2. Determination of vital signs is within
the scope of practice of the nursing
assistant and is an appropriate task for
the RN to delegate.
3. RNs perform all patient teaching. Therefore, it is not appropriate to delegate this
task to a nursing assistant.
4. ADLs are appropriate for the RN to
delegate to a nursing assistant.
5. Daily weights are appropriate for the
RN to delegate to a nursing assistant.
TEST-TAKING HINT: The test taker must
know which tasks can be assigned to nursing assistive personnel. Baseline assessments and patient teaching are never delegated and must be completed by the RN.
Vital signs and ADLs are within the scope
of practice of a nursing assistant and may
be delegated.
29. 1, 3, 4, 5.
1. All education must be completed by
the RN and cannot be delegated. This
includes insulin administration.
2. Blood glucose monitoring is within the
scope of practice of an LPN/LVN and
nursing assistant and can be delegated by
the RN.
3. Evaluation of a patient’s responses to
treatments and medications must be
completed by the RN and cannot be
delegated.
4. Determining the plan of care, including educational goals, must be completed by the RN. This task is not
within the scope of practice of the
LPN/LVN or nursing assistant.
5. Teaching the child about hypoglycemia and hyperglycemia is the responsibility of the RN and cannot be
delegated.
TEST-TAKING HINT: Determining the plan
of care and patient teaching are functions
that are only within the scope of practice
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of the RN and cannot be delegated to an
LPN/LVN or nursing assistant.
30. 1. This might not be the best match between patient and nurse, if the emotions
of the nurse who recently lost a child are
still overwhelming.
2. A new-graduate LPN/LVN might not be
intravenous certified and would probably
have little experience with central intravenous line malfunctions. Some states
exclude LPNs/LVNs from working with
central intravenous lines.
3. Even though the pediatric oncology
nurse has floated to the pediatric unit,
this patient’s care involves routine
skills and knowledge used in the
nurse’s oncology practice. This makes
this assignment the best example of
“right task to right person.”
4. Extensive teaching is involved for a child
with new-onset diabetes. The nurse with
a very busy assignment is not likely to
have the time required for teaching.
TEST-TAKING HINT: The “right task” is one
that can be safely and effectively assigned
to the nursing staff person who has the
knowledge and skills required. In answers
1 and 4, the nurse may be distracted by
interpersonal or environmental factors. In
answer 2, the new-graduate LPN/LVN
may not have the skills. Answer 3 is the
best answer because the oncology nurse
is likely to have the needed knowledge
and skills.
31. 1. The hospital’s policies and procedures
must be based on the state’s nurse practice
act and is a secondary resource.
2. The nurses’ association in each state
focuses on the welfare of nurses, not the
legal scope of practice.
3. Educational programs for nursing assistants must take scope of practice into
consideration, but they are not the legally
defining bodies.
4. Each state establishes legal guidelines
for health-care professionals in various
roles. These guidelines are in the
state’s nurse practice act, which is the
ultimate legal document.
TEST-TAKING HINT: The word primary is
the key to answering this question. Each
state has its own definition of scope of
practice for different nursing roles. These
are legal definitions, passed by the state
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legislature and are therefore the primary
sources of information.
32. 1. Rules of management dictate that the RN
does not delegate the function of patient
teaching.
2. Rules of management dictate that the
RN does not delegate the function of
assessment.
3. Rules of management dictate that the
RN does not delegate the function of
evaluation.
4. The nursing assistant may help the
patient in hygiene matters, including
bathing.
TEST-TAKING HINT: When answering delegation questions, follow the rules of
nursing management. The RN does not
delegate assessment, teaching, or evaluation to unlicensed personnel such as
nursing assistants.
33. 1. Fever is likely to be the most acute
problem of this infant, but it is not life
threatening.
2. Following the ABCs (airway, breathing, circulation), this baby has the
greatest potential for a life-threatening
complication if the tracheostomy becomes obstructed by mucus.
3. Although fever and discomfort may need
prompt attention, neither one is life
threatening.
4. Pain is the critical assessment area for this
child, but it is not life threatening
TEST-TAKING HINT: The question is asking
the nurse to prioritize care based on
physiological parameters. The toddler in
answer 2 presents the greatest possibility
for an acute life-threatening complication—respiratory obstruction. Although
other patients are acutely ill, their conditions are more stable and unlikely to be
life threatening.
34. 1. This child is experiencing a psychological
crisis. The child is alert and mobile, behavior that indicates there are no severe
physical injuries.
2. Presentation indicates possible abdominal injury and internal bleeding in early
shock. With immediate attention, the
injuries may be treatable; therefore,
this child should be seen first.
3. Relief of pain is this child’s immediate
priority, which is not life threatening.
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4. Although this child is the sickest, presentation indicates irreversible brain injury;
therefore, this child would not be the first
priority for treatment.
TEST-TAKING HINT: Physiological injuries
always take priority over psychological
issues, eliminating answer 1. If a patient
cannot be saved, the patient does not
need to be seen first, eliminating answer
4. Of the two remaining answers, the
child in answer 2 is the most unstable and
should be treated first.
35. 1. The best method for preventing contamination of the central intravenous
line site is to complete this procedure
first. This lessens the likelihood of
spreading microorganisms from the GI
track to the central line. The possible
complication of sepsis is most life
threatening.
2. Accurate measurement of output and
maintaining patency of the ileostomy bag
are lower priority than preventing sepsis
of the central intravenous line.
3. Maintaining patency of the Jackson Pratt
drain and dressing is lower priority than
maintaining asepsis of the central intravenous line.
4. Correct positioning of the nasogastric tube
is lower priority than prevention of sepsis.
TEST-TAKING HINT: Determine which principle of care supersedes the others. In this
case, maintaining sterility of the central
intravenous line takes precedence over accuracy of output, patency of an abdominal
dressing, or nasogastric tube position.
36. 1. Physiological needs take priority over
other needs; therefore, hypotension is
the priority need.
2. Fear of being alone falls within the “security” category, which is lower than physiological needs.
3. Frustration with immobility falls within
the “self-esteem” category, which is lower
than physiological needs.
4. Body image concerns fall within the category of “self-esteem,” which is lower than
physiological needs
TEST-TAKING HINT: Maslow’s Hierarchy of
Needs begins with physiological needs
and proceeds to safety and security, love
and belonging, self-esteem, and selfactualization. Hypotension is the only
clear physiological need listed.
37. 1. Sedation is to be expected and is not the
greatest concern.
2. Airway and breathing complications
are the most serious side effects.
3. As long as the nurse is careful to prevent
aspiration, nausea and vomiting are less
serious side effects.
4. Constipation is a more long-term and less
serious side effect.
TEST-TAKING HINT: Prioritizing following
the ABCs (airway, breathing, circulation)
indicates that respiratory depression
is the most dangerous side effect of
treatment.
38. 1. This question can be answered by collecting data on medication errors on each
unit and comparing the data.
2. This research question can be answered
by comparing pain scores for infants with
and without local anesthesia.
3. This is a legal/ethical issue that is
guided by state mandates and the
nurse’s values of altruism and justice.
4. This question involves a nursing treatment (irrigation) and patient outcomes
(line obstruction and infection) that can
be determined through action and data
collection.
TEST-TAKING HINT: This question involves
ethical principles such as altruism (doing
good for another), human dignity (each
individual has intrinsic worth), and justice
(treat persons equally).
39. 1. Autonomy is the right to make one’s
own decisions, in this case, the right of
the parent to make decisions about the
child’s surgery. As legal guardian, the
parent has the right to choose or not
choose for the child to undergo an
elective procedure.
2. Equality is the value for uniformity or
evenness between cases or patients. This
is not directly related to the situation.
3. Fidelity means keeping promises or
agreements. While important in any
nurse-parent interaction, it is not the
focus of this situation.
4. Justice is the moral principle of fairness.
Although this is a universal principle
of care, it is not the main issue in this
situation.
TEST-TAKING HINT: By knowing the meaning of each principle or value, the test
taker can select the correct one.
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40. 1. This answer is based on the assumption
that the couple’s relationship involves
abuse; however, this has yet to be established.
2. Only after the nurse clarifies that the
mother is experiencing violence will this
answer be appropriate.
3. Clearly identifying the problem, as
suggested in this answer, is the first
step in the ethical decision-making
process.
4. This statement is an example of the consideration of causative factors; however, the
problem has not been clearly identified yet.
TEST-TAKING HINT: Ethical decision making follows steps that closely resemble the
nursing process: identify the problem,
consider causative factors, explore answers for action, develop a plan, implement the action, and evaluate the results.
41. 1. This situation involves differences of
opinion among persons who have a
legal responsibility to make decisions
for the child. Consultation by the multidisciplinary members of the ethics
committee may help caregivers reach
an agreement.
2. Routine care and consent are involved
in this situation. No ethical dilemma is
apparent.
3. Chemotherapy protocols require parental
consent and, when appropriate, child assent before implementing. In this situation, all are in agreement about care;
therefore, no ethical dilemma is involved.
4. Parents in this situation are given information and asked to make decisions about
two possible courses of treatment. Although each course has advantages and
disadvantages, both are acceptable for
treating the diagnosis. Unless parents
disagree on what course to pursue, there
is no ethical dilemma.
TEST-TAKING HINT: Ethics committees
provide a forum for discussing different
views, especially when caregivers, patients, or providers differ in their preferences for treatment. A situation most
likely to be reviewed by a committee is
one involving differences of opinion about
what should be done for a child.
42. 1. The user name can often be linked to the
system user’s real name and is not considered confidential.
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2. The user ID can often be linked to the
system user’s real name and is not considered confidential.
3. A password uniquely identifies a user
and provides access to data appropriate
to the user. System users must maintain confidentiality of their password.
4. The credentials of the system user are not
considered confidential.
TEST-TAKING HINT: System users must
never share their passwords. When the
nurse signs onto a system, data and information that are entered can be traced to
that nurse’s password. The nurse is accountable for all actions linked to that
password.
43. 1. Although this action gives immediate
attention to the patient, it violates confidentiality of patient information by leaving the computer screen open.
2. Changing the computer to suspend
mode requires only a few seconds.
This answer is the best choice, because confidentiality is maintained
and the patient receives prompt
attention.
3. The amount of information left to be
recorded is unknown, and completing
charting may delay the assistance needed
by the parent.
4. How soon will another staff member be
able to assist the patient? Because this
information is unknown, meeting patient
needs may be delayed.
TEST-TAKING HINT: Two issues are involved:
meeting patient needs in a timely manner
and maintaining confidentiality of patient
information. This clinical situation does
not appear to be a true emergency. Therefore, confidentiality takes priority and
should be maintained by closing the computer screen before leaving the computer
unattended.
44. 1. Although staff members may have access
to their own records, HIPAA regulations
disallow personal access that bypasses institutional policies and procedures.
2. As in answer 1, this access is disallowed
under HIPAA regulations.
3. The right to access information is based
on the need to know this information
to provide patient care. Staff must have
access to records of assigned patients in
order to provide care.
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4. As in answers 1 and 2, this access is disallowed under HIPAA regulations.
TEST-TAKING HINT: In order to maintain
patients’ rights and confidentiality of
health-care information, HIPAA regulations spell out the standard for accessing
patient information—a need to know for
the performance of the job.
45. 1. Individually identifiable health information, such as patient name or ID number,
may be shared via fax with other healthcare personnel who have a need to know
the information to provide care.
2. As in answer 1, this information may be
mailed to others who have a need to know
to provide proper care.
3. Following the “need to know” rule,
individually identifiable information may
be copied, as long as confidentiality is
maintained.
4. Selling information, such as lists of
names and addresses, is disallowed by
law, because the purpose of sharing the
information is not the provision of care.
TEST-TAKING HINT: The key to sharing or
utilizing health information that can be
traced to an individual patient is the
“need to know” to provide individual
health care. Confidentiality must be maintained, and providers may not benefit
financially by selling such information.
46. 1. Abuse alone is not a basis for emancipation.
2. Pregnant minors are considered emancipated minors in many U.S. states and
are able to give informed consent.
3. A diagnosis of cancer is not a basis for
emancipation.
4. Attending college is not a basis for
emancipation.
TEST-TAKING HINT: Emancipated minors
are individuals younger than 18 years of
age who are able to give valid informed
consent. State statutes mandate who can
be considered emancipated. Examples include pregnant females and adolescents
treated for substance abuse or communicable disease.
47. 1. Use of a competent translator does not
violate the method of obtaining informed
consent.
2. This situation violates the principle
of informed consent. Despite signing
the written consent form, the parents
state a lack of understanding of the
procedure.
3. As long as full information is revealed to
parents, the timing of information can
vary. This situation does not violate the
principle of informed consent.
4. It is acceptable for either parent to sign
the consent, if both have custody of the
child. This practice does not violate
the principle of informed consent.
TEST-TAKING HINT: The primary care
provider is responsible for informing the
legal guardian of a pediatric patient about
a procedure and its potential benefits and
risks. Criteria that must be satisfied for
informed consent are the following: The
person giving consent must understand
the procedure, expected outcomes, risks
or side effects, and alternate treatments;
and a person who is considered legally
capable, such as a legal guardian or parent, must give consent.
48. 1. Assent is the process by which children give their consent for medical
treatment. Assent does not have the
same legal implications as informed
consent, which is given by parents or
legal representatives.
2. Children younger than 18 years cannot
give legal informed consent unless they
are emancipated minors. Parents serve as
children’s legal representatives and give
informed consent.
3. Confidentiality is one component of the
consent process, but it is not a term used
to designate the consent process.
4. Emancipation is a different process from
consent for treatment. Emancipated
minors may include pregnant adolescents and minors seeking treatment
for substance abuse or communicable
diseases.
TEST-TAKING HINT: The test taker must
understand the legal implications of informed consent. Informed consent is
based on legal capacity, voluntary action,
and comprehension. Unless a child is an
emancipated minor, he or she does not
have the legal capacity to give informed
consent. However, a child younger than
18 years may be able to comprehend the
implications of treatment and give voluntary assent.
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49. 2, 3, 5.
1. Although this is helpful information for a
patient, it is not required on the informed
consent form.
2. Alternative treatments are part of the
informed consent process.
3. Benefits likely to result from the procedure are part of the process of informed consent.
4. Only the names of the persons performing the procedure are required for informed consent.
5. The statement that the patient may
withdraw consent at any time is required for informed consent.
TEST-TAKING HINT: Information required
for informed consent includes an explanation of the procedure, risks involved, benefits likely to result, options other than
the procedure, name of the person(s) performing the procedure, and statement
that the patient may withdraw consent at
any time.
50. 1. Scope of practice refers to the legally permissible boundaries of practice and is applicable to all RNs. In this situation, it is
the float nurse’s lack of familiarity with
care, rather than scope of practice, that
influences the legal responsibility of the
charge nurse.
2. The charge nurse has a duty to orient
the float nurse to the pediatric unit,
educate the nurse on any unfamiliar
procedures, and evaluate the float
nurse’s competency to provide care.
3. The patient’s right to competent care can
be maintained as long as the assignment
of the float nurse is implemented to meet
care standards.
4. In this situation, the established nurse/
patient ratio may be maintained and is
not the primary issue raised by floating a
nurse from another unit.
TEST-TAKING HINT: Floating nurses from
one clinical unit to another to fill a
staffing vacancy can be an effective strategy, if floating guidelines are met. The
charge nurse is responsible for ensuring
that the floating nurse has the required
competencies for working on the unit and
is supported in carrying out the assigned
care. This legal responsibility includes the
supervisory duty to orient, educate, and
evaluate the floating staff.
AND
MANAGEMENT
51. 1. The nurse has a relationship with the patient because the nurse has been assigned
to care for the child in the hospital. This
element is present.
2. Breach of duty of care is missing
in this case, because the nurse met
the standard of care. The nurse educated the parent on the importance
of side rail safety before the incident
occurred.
3. The element of injury is present in this
case, because the child suffered a skull
fracture.
4. The child sustained damage in this case,
as evidenced by the skull fracture.
TEST-TAKING HINT: In order for malpractice to be proved, four elements must be
present: The nurse has a relationship
with the patient by being assigned to
care for the patient; the nurse failed to
observe a standard of care in the specific
situation; the patient sustained harm, injury or damage; and the harm must have
occurred as a direct result of the nurse’s
failure to act in accordance with the
standard of care.
52. 1. Each state’s nurse practice act defines the
scope of nursing practice, such as what
level of practitioner can initiate a blood
transfusion.
2. The national HIPAA is in place to ensure
that providers protect the privacy and
security of health information.
3. Each state has a Good Samaritan act to
protect health-care workers who give
assistance in emergency situations.
4. The local agency’s policy manual
would describe acceptable procedures
for performing specific skills, such as
flushing a central venous line. These
procedures serve as the legal standard
of care.
TEST-TAKING HINT: The nurse needs to
know major laws that govern practice, at
both state and national levels. Where
these laws exist, they serve as the primary
legal authority for care. Examples include
nurse practice acts, Good Samaritan acts,
HIPAA, the Patient Self-Determination
Act, and child and elder abuse reporting.
The legal basis for most specific technical
procedures can be found in agencies’ policy and procedure manuals.
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53. 1. The parent’s refusal to allow the nurse
to continue constitutes a revocation of
informed consent; therefore, the nurse
is acting without permission. In addition, the nurse should consult the
agency policy and procedure manual
regarding the number of attempts
allowed in this procedure.
2. Normal toddler behavior is being exhibited here. This response might occur despite use of analgesics, parental presence,
and other coping measures.
3. Many young children have difficulty taking oral medication, and this situation
falls within normal parameters.
4. Initial refusal of a painful activity is typical behavior for a school-aged child, but it
can often be overcome by motivational
and diversional measures.
TEST-TAKING HINT: Battery is intentional
physical contact that is wrongful in some
way, such as causing embarrassment or
injury or done without permission. In pediatrics, the parent gives consent for the
child and must give permission for a procedure of this type.
54. 1. After an error occurs, the nurse should
document what occurred and what was
done to solve or treat the problem.
2. The fact that an incident report was completed should not be documented in the
patient medical record.
3. No information regarding the incident
report should be documented in the
patient medical record.
4. The facts concerning the medication
error should be recorded, because of the
effect on the patient’s health status.
TEST-TAKING HINT: An incident report helps
an organization track patient care–related
problems. The facts of what occurred, the
effect on the patient, and the treatment
given should be recorded.
55. 1. Administration of a medication dose
outside the therapeutic range is an execution error and should be reported
as a critical incident. The nurse is
held responsible for administering the
wrong dose, just as the physician is responsible for ordering the wrong dose.
2. This event is not considered to be a
nursing error because it is not under the
control of the nurse, if proper flushing
protocol has been followed. Rather, it is
a complication of intravenous therapy.
3. This event is a complication of intravenous therapy and is not a nursing error.
4. This event is an example of the challenges
of giving oral medications to uncooperative children and is not considered a nursing error.
TEST-TAKING HINT: The goal of risk management is to promote quality patient
care and minimize adverse outcomes.
Medication errors are monitored through
incident reporting. Events that represent
a departure from safe practice, with or
without resulting harm to the patient,
should be reported.
56. 1. This answer is an example of a violation of the policy for administering a
high-risk drug such as insulin. Policy
dictates that another RN (not a nursing assistant) double-check the dose
before administering.
2. This is an example of a potential error
that was corrected appropriately before it
was completed.
3. This is an example of appropriate verification of orders.
4. This is an example of appropriate doublechecking of a high-risk drug.
TEST-TAKING HINT: The goal of risk management is to create an awareness of potential risk factors and set up various mechanisms to control and/or eliminate risk.
The protocol for high-risk medications, including insulin, is to check the dose with
another RN before administering.
57. 1. Fasting blood glucose level may be used
as a diagnostic test.
2. Fingerstick blood glucose values reflect
compliance over the previous 1–2 days,
making this test less valid as a long-term
indicator of compliance. This test allows
for short-term adjustment of the therapeutic regimen.
3. Urine ketones are measured to detect diabetic ketoacidosis.
4. HgA1C reflects the average blood glucose level over 3 months, making it
the most valid indicator.
TEST-TAKING HINT: Blood glucose levels
are the best indicators of compliance with
insulin, diet, and exercise regimens in diabetes. Long-term measurements, such as
HgA1C, are better indicators than shortterm levels, such as fasting glucose or
fingerstick glucose checks.
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58. 1. The charge nurse needs to validate correct understanding of what was observed
by speaking with the staff nurse before
addressing the parent.
2. Until validation with the staff, the charge
nurse does not know whether a problem
has occurred.
3. Verbal assessment and validation of the
situation should occur before a written
reprimand.
4. Validation of information that was actually communicated to the parent should
be the next step. This should come from
the staff nurse in a private discussion.
TEST-TAKING HINT: Before disciplinary
action is taken in regard to any personnel
situation, the charge nurse should give the
staff member the opportunity to discuss
the situation from the personal viewpoint.
59. 1. Social interactions among staff are not
necessarily within the jurisdiction of the
nurse manager.
2. The cafeteria is not a responsibility of
nursing administration, and staff would
better facilitate change by giving input
directly to this department.
3. This is a patient care issue that will take
some investigation and correction on a
unit-to-unit level. Pediatric unit and
emergency department managers should
be involved. This situation is most appropriate to refer to nurse managers.
4. Union policies are separate from hospital
administration and nursing management.
TEST-TAKING HINT: Focus on the role of
the nurse manager and the activities under that role. Only answer 3 focuses on
events that are within the job description
of the nurse manager.
AND
MANAGEMENT
60. 1. Employing a sitter is not a cost-effective
solution because the child is not in danger
when adults are out of the room.
2. Parents need break times to deal with the
stress of having a hospitalized child. It is
unreasonable to expect them to stay at the
bedside 24 hours a day.
3. The role of the child life–worker is
to help hospitalized children meet
normal developmental needs. Referring to them is the most appropriate
action.
4. The behavior shown is normal and does
not indicate unusual social or emotional
needs. Therefore, a social service consult
is not indicated.
TEST-TAKING HINT: The child has difficulty
only on the occasions that parents are absent, indicating a need for attention from
staff or the diversion of play activities. A
child life–worker is the best staff person
to meet these needs.
61. 1. The role of case manager includes
ordering medical equipment for discharge; therefore, this is an appropriate referral.
2. Most nurse manager activities are broader
in scope than discharge planning.
3. Materials management stocks hospital
supplies but is usually not involved in discharge supplies.
4. Child life staff members focus on emotional needs during hospitalization and
would not be involved in this aspect of
discharge planning.
TEST-TAKING HINT: The test taker must
know the role of each staff member listed.
Obtaining equipment for discharge is an
important role of the case manager.
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14
KEYWORDS
The following words include English vocabulary, nursing/medical terminology, concepts, principles,
or information relevant to content specifically addressed in the chapter or associated with topics
presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as
Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowledge
and understanding of these words and related information.
Acetaminophen (Tylenol)
Albuterol (Proventil)
Amoxicillin (Amoxil)
Amoxicillin/clavulanate potassium
(Augmentin)
Amphotericin B
Anticholinergic
Baclofen
Benadryl (diphenhydramine)
Benzoyl peroxide
Carbamazepine (Tegretol)
Chlorhexidine (Hibiclens)
Ciprofloxacin (Cipro)
Collagenase (Santyl)
Cyclophosphamide (Cytoxan)
Dalteparin sodium (Fragmin)
Deferoxamine (Desferal)
Dexamethasone (Decadron)
Diclofenac (Voltaren)
Digoxin (Lanoxin)
Diltiazem (Cardizem)
Erythromycin
Filgrastim (Neupogen)
Gamma globulin
Gentamycin
Growth hormone
Ibuprofen
Ifosfamide
Indomethacin
Intradermal
Isotretinoin (Accutane)
Levothyroxine (Synthroid)
Lindane (Kwell, G-Well)
Mesna (Mesnex)
Metoclopramide (Reglan)
Morphine (morphine sulfate)
Nasal decongestant
NPH insulin
Oxybutynin (Ditropan)
Pancreatic enzymes
Penicillin
Phenytoin (Dilantin)
Prednisone
Prostaglandin E
Pyrantel pamoate (Antiminth)
Ribavirin (Virazole)
Rifampin (Rifadin)
Salicylic acid
Sympathomimetic
Terbinafine (Lamisil)
Trimethoprim/sulfamethoxazole (Septra)
Vancomycin
Vastus lateralis
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ABBREVIATIONS
Cerebral palsy (CP)
grain (gr)
gram (g)
milligram (mg)
pound (lb)
CONVERSIONS
1 fl ounce = 30 mL (fluid volume)
1 g = 15 gr
1 g = 1000 mg
1 gr = 60 mg (or 65 mg for Tylenol or
aspirin)
1 in = 2.54 cm
1 kg = 2.2 lb
1
1
1
1
1
L = 1000 mL
lb = 454 g
lb = 16 ounces
mg = 1000 mcg
ounce = 28 g (weight)
QUESTIONS
1. A child is to receive phenytoin (Dilantin) 100 mg IV for seizure prophylaxis. Which
intervention is appropriate when administrating this drug?
1. Mix it in dextrose 5% in water and give over 1 hour.
2. Administer no faster than 2 mg/kg/min.
3. Do not use an inline filter.
4. Monitor temperature prior to and after administration.
2. The parent of a child who is being discharged from the clinic wants to know if there is
a difference between Advil and ibuprofen, saying, “I can buy ibuprofen over the
counter at a cheaper price than Advil.” What is the nurse’s best response?
1. “Advil and ibuprofen are two different drugs with similar effects.”
2. “There is no difference between the two medications, so you should use whichever
one is cheaper.”
3. “Similarities exist between the drugs, but you need to consult the physician about
the specific order.”
4. “Ibuprofen is usually cheaper, so you should use it.”
3. What time would the nurse most likely see signs and symptoms of hypoglycemia after
administering NPH insulin at 0730?
1. 0930 to 1030.
2. 1130 to 1430.
3. 1130 to 1930.
4. 1530 to 1930.
4. Morphine sulfate 2 mg IV q2h prn for pain is ordered for a 12-year-old who has had
abdominal surgery. Which is the most appropriate nursing action?
1. Administer the morphine sulfate using a syringe pump over 1 hour.
2. Encourage the child to do incentive spirometer every hour during the day and
when awake at night.
3. Ask the physician to change the medication to Demerol (meperidine).
4. Administer the morphine sulfate with Benadryl (diphenhydramine) to prevent itching.
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5. The parent of a child who is being treated for Haemophilus influenzae meningitis tells
the nurse that the family is being treated prophylactically with rifampin (Rifadin).
Which should the nurse include in teaching about this medication?
1. “The drug will change the color of the urine to orange-red, so you should protect
your undergarments as it will cause staining.”
2. “Adverse effects of the drug may cause urinary retention.”
3. “The drug is given to treat meningitis.”
4. “You will need to continue taking the drug for 7 days.”
6. A 2-year-old child has been prescribed amoxicillin (Amoxil) tid for treatment of
pharyngitis. Which statement indicates the parent knows how to give the medication?
1. “If I miss giving my child a dose at lunch, I will double up on the dose at night.”
2. “I will give the medication at breakfast, lunch, and dinner.”
3. “I know that amoxicillin (Amoxil) is a chewable tablet, but sometimes my child
likes to swallow it whole.”
4. “I will continue giving the amoxicillin (Amoxil) for 10 days even if my child’s
cough gets better.”
7. A nurse is caring for a child who is receiving amphotericin B IV daily for a fungal
infection. Prior to starting the therapy, which should the nurse review?
1. Aspartate aminotransferase and alanine aminotransferase levels.
2. Serum amphotericin level.
3. Serum protein and sodium levels.
4. Blood urea nitrogen, and creatinine levels.
8. Which toxicity is specific to gentamicin?
1. Hepatatoxicity.
2. Ototoxicity.
3. Myocardial toxicity.
4. Neurotoxicity.
9. A nurse is administrating vancomycin intravenously and sets the pump to infuse the
medication over 90 minutes. Which adverse reaction is the nurse trying to prevent?
1. Vomiting.
2. Headache.
3. Flushing of the face, neck, and chest.
4. Hypertension.
10. The parents of an 8-year-old come to the clinic and ask the nurse if their child should
receive growth hormone to boost short stature. Which is the nurse’s best response?
1. “Growth hormone only works if the child has short bones.”
2. “Can your child remember to take the pills every day?”
3. “Scientific evidence is required before growth hormone can be started in children.”
4. “How tall do you think your child should be?’
11. A child has been receiving prednisone for the past 3 weeks, and the parent wants to
stop the medication. What is the nurse’s best response?
1. “There should be no problem in stopping the medication since the child’s
symptoms have gone away.”
2. “It is dangerous for steroids to be withdrawn immediately.”
3. “Your child may develop severe psychological symptoms when prednisone is
stopped.”
4. Stopping the prednisone will require serum blood work.”
12. A child who has been diagnosed with hypothyroidism is started on levothyroxine
(Synthroid). Which should be included in the nurse’s teaching plan?
1. The child will have more energy the next day after starting the medication.
2. Optimum effectiveness of the medication may not occur for several weeks.
3. The medication should be taken once a day at any time.
4. The medication should be taken with milk.
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13. Which should the nurse include in the discharge teaching plan for a child beginning
growth hormone therapy?
1. The child is expected to grow 3 to 5 inches during the first year of treatment.
2. The parents must measure the child’s weight and height daily.
3. The parents will need to continue the therapy until the child is 21 years old.
4. There are no side effects from taking growth hormones.
14. The onset of Humalog insulin is:
1. 10 to 15 minutes.
2. 30 minutes to 1 hour.
3. 1 to 2 hours.
4. 2 to 4 hours.
15. Which should the nurse include in the teaching plan for a child started on metoclopramide (Reglan)?
1. This drug increases gastrointestinal motility.
2. The drug decreases tone in the lower esophageal sphincter.
3. The drug prevents diarrhea.
4. The drug induces the release of acetylcholine.
16. The nurse will monitor a child on high-dose prednisone for:
1. Diabetes.
2. Deep vein thrombosis.
3. Nephrotoxicity.
4. Hepatotoxicity.
17. A nurse is administering cyclophosphamide (Cytoxan) to a child with leukemia.
Which action by the nurse would be appropriate?
1. Monitoring serum potassium levels.
2. Checking for hematuria.
3. Obtaining daily weights.
4. Getting neurological checks every 4 hours.
18. A nurse is giving ifosfamide as chemotherapy for a child who has leukemia. Mixed in
with the ifosfamide is mesna (Mesnex). Mesna is given for which reason?
1. Combination chemotherapy.
2. An antiarrhythmic.
3. Prevent hemorrhagic cystitis.
4. Increase absorption of the chemotherapy.
19. Which should a nurse anticipate to be prescribed in chelation therapy in a child receiving frequent blood transfusions?
1. Dalteparin sodium (Fragmin).
2. Deferoxamine (Desferal).
3. Diclofenac (Voltaren).
4. Diltiazem (Cardizem).
20. Why is filgrastim (Neupogen) given to a child who has received chemotherapy?
1. Reduce fatigue level.
2. Prevent infection.
3. Reduce nausea and vomiting.
4. Increase mobilization of stem cells.
21. A child comes to the clinic for diphtheria, pertussis, and tetanus (DTaP) and inactivated poliovirus vaccines. The child does not appear ill but has a temperature of
101°F (38.3°C). The nurse should take which action?
1. Withhold the vaccines, and reschedule when the child is afebrile.
2. Administer Tylenol, and give the vaccine.
3. Give the vaccines, and instruct the parent to give Tylenol every 4 hours as needed.
4. Have the physician order an antibiotic and give the vaccine.
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22. Which would the nurse instruct a parent to apply to treat a pediculosis infestation?
1. Lindane (Kwell) to the scalp, leaving it in place for 4 minutes, and then adding
water.
2. Chlorhexidine (Hibiclens) to the scalp with sterile gloves.
3. Terbinafine (Lamisil) as a thin layer to the scalp twice a day.
4. Collagenase (Santyl) to the scalp with cotton applicator.
23. Amoxicillin (Amoxil) 250 mg PO q8h is prescribed for a child who weighs 42 lb to
treat strep throat. The desired dose is 50 mg/kg/day. The nurse determines that:
1. The prescribed dose is too low.
2. The prescribed dose is too high.
3. The prescribed dose is safe.
4. Not enough information is given to determine the safe dose.
24. A child with a heart defect is placed on a maintenance dose of digoxin (Lanoxin)
elixir. The dose is 0.07 mg/kg/day, and the child’s weight is 16 lb. The medication is
to be given two times a day. The nurse prepares how much digoxin (Lanoxin) for the
morning dose?
1. 0.25 mg.
2. 0.37 mg.
3. 0.5 mg.
4. 2.5 mg.
25. Ciprofloxacin (Cipro) 300 mg daily is ordered for a child with a urinary tract infection. The medication comes 250 mg/5 mL. How much of the medication will the
nurse prepare to give to the child?
1. 1.2 mL.
2. 3 mL.
3. 6 mL.
4. 12 mL.
26. A nurse is caring for a child with congenital heart disease who is being treated with
digoxin (Lanoxin). Which is included in the family’s discharge teaching?
1. Make sure the medication is taken with food.
2. Repeat the dose if the child vomits.
3. Take the child’s pulse prior to administration.
4. Weigh the child daily.
27. Which medication is the most effective treatment for acne?
1. Salicylic acid.
2. Benzoyl peroxide.
3. Chlorhexidine (Hibiclens).
4. Collagenase (Santyl).
28. Which would the nurse recommend to an adolescent female beginning isotretinoin
(Accutane) therapy?
1. Apply a thin layer to the affected skin twice a day.
2. Use Hibiclens for added benefit.
3. Have a pregnancy test prior to starting treatment.
4. Keep lips moistened to prevent inflammation.
29. Which medication is used for the treatment of spasticity in cerebral palsy (CP)?
1. Dexamethasone (Decadron).
2. Baclofen.
3. Diclofenac (Voltaren).
4. Carbamazepine (Tegretol).
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30. Which assessment should be a priority to monitor in a child receiving a narcotic for
pain relief?
1. Respirations.
2. Bowel sounds.
3. Blood pressure.
4. Oxygen saturation.
31. Which is the correct method to instill eardrops in a 5-year-old?
1. Pull the pinna of the ear downward and back for instillation.
2. Place cotton tightly in the ear after instillation.
3. Have the child remain upright after instillation.
4. Pull the pinna of the ear upward and back for instillation.
32. A physician has ordered amoxicillin (Amoxil) 500 mg IVPB q8h for a child with
tonsillitis. Which action by the nurse is appropriate?
1. Question the order because the route is incorrect.
2. Give the medication as ordered.
3. Call the physician because the dosing frequency is incorrect.
4. Call the physician, and question the dose of the drug.
33. Which should the nurse do first for a child diagnosed with conjunctivitis and ordered
to have eye ointment applied three times a day?
1. Remove any discharge from the affected eye.
2. Ensure the ointment is at room temperature.
3. Hold the tip of the eye ointment dropper parallel to the eye.
4. Wash hands.
34. Which instruction about nasal drops should be included in the teaching plan for the
parents of a child with nasopharyngitis?
1. “Do not use the drops for any other family member.”
2. “Administer the drops as often as necessary until the nasal congestion subsides.”
3. “Insert the dropper tip as far back as possible to make sure the medication is in
the nasal passage.”
4. “You can save the drops for the next time your child has the same symptoms.”
35. Trimethoprim/sulfamethoxazole (Septra) should be given with:
1. Breakfast and dinner.
2. A snack.
3. Glass of water.
4. A cola beverage.
36. An IV infusion of gamma globulin 2 g/kg over 12 hours has been ordered for a 22-lb
child. Which dose is correct?
1. 11 g.
2. 20 g.
3. 22 g.
4. 44 g.
37. Lindane (G-Well) shampoo is used only once because it can cause:
1. Hypertension.
2. Seizures.
3. Elevated liver functions.
4. Alopecia.
38. Which is essential for the nurse to teach the parent regarding administration of
pyrantel pamoate (Antiminth)?
1. Fever and rash are common adverse effects.
2. The medication kills the eggs in about 48 hours.
3. The drug may color the urine red.
4. The dose should be repeated in 2 weeks.
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39. A 6-month-old is prescribed 2.5% hydrocortisone for topical treatment of eczema.
The nurse instructs the parent not to use the cream for more than a week. What is
the primary reason for this instruction?
1. Adverse effects, such as skin atrophy and fragility, can occur with long-term
treatment.
2. If after a week there is no improvement, then a stronger dose is required.
3. The drug loses its efficacy after prolonged use.
4. If no improvement is seen after a week, an antibiotic should be prescribed.
40. A 15-kg child is started on cephalexin (Keflex) for treatment of cellulitis. The dose is
40 mg/kg/day, given twice a day. The nurse has a bottle of Kelflex that indicates
there are 250 mg/5 mL. How many milliliters must the nurse draw up for each dose?
1. 2.5 mL.
2. 6 mL.
3. 12 mL.
4. 20 mL.
41. A child with hives is prescribed diphenhydramine (Benadryl) 5 mg/kg per day in
divided doses every 6 hours. The child weighs 40 lb. How many milligrams should
the nurse give for each dose?
1. 4.5 mg.
2. 11.45 mg.
3. 22.75 mg.
4. 50 mg.
42. When is the best time to give furosemide (Lasix)?
1. 8:00 a.m.
2. 12 noon.
3. 6:00 p.m.
4. Bedtime.
43. Which assessment finding should the nurse observe following administration of
albuterol (Proventil)?
1. Decrease in wheezing.
2. Decrease in respiratory rate from 34 to 22.
3. Decrease in blood pressure.
4. Decrease in heart rate.
44. A child in the emergency room is being treated with albuterol (Proventil) aerosol
treatments for an acute asthma attack. She requires treatments every 2 hours. Which
adverse effect of the medication would the nurse expect?
1. Lethargy and bradycardia.
2. Decreased blood pressure and dizziness.
3. Nervousness and tachycardia.
4. Increased blood pressure and fatigue.
45. A child with cystic fibrosis (CF) is placed on an oral antibiotic to be given four times
a day for 14 days. Which of the following schedules is the most appropriate?
1. 8 a.m.,12 p.m., 4 p.m., 8 p.m.
2. 7 a.m., 1 p.m., 7 p.m., 12 midnight.
3. 9 a.m., 1 p.m., 5 p.m., 9 p.m.
4. 10 a.m., 2 p.m., 6 p.m., 10 p.m.
46. Which is the best area for the tuberculin skin test to be placed?
1. Upper thigh.
2. Scapular area.
3. Back.
4. Ventral forearm.
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47. A hospitalized child is to receive 75 mg of acetaminophen (Tylenol) for fever of
101°F (38.3°C). If the acetaminophen (Tylenol) is 80 mg per 0.8 mL, how much will
the nurse administer?
1. 0.75 mL.
2. 1.5 mL.
3. 2.5 mL.
4. 3 mL.
48. Which is a toxic reaction in a child taking digoxin (Lanoxin)?
1. Weight gain.
2. Tachycardia.
3. Nausea and vomiting.
4. Seizures.
49. A 10-month-old with heart failure weighs 10 kg. Digoxin (Lanoxin) is prescribed as
10 mcg/kg/day to be given every 12 hours. How much is given for each dose?
1. 10 mcg.
2. 50 mcg.
3. 100 mcg.
4. 500 mcg.
50. Why is indomethacin given to a preterm neonate?
1. Encourage ductal closure.
2. Prevent hypertension.
3. Promote release of surfactant.
4. Protect the immature liver.
51. Which drug is most important in treating an infant with transposition of the great
vessels?
1. Digoxin (Lanoxin).
2. Antibiotics.
3. Prostaglandin E.
4. Diuretics.
52. Penicillin is given to a 2-year-old prior to dental work. The child weighs 44 lb. The
order is for 25 mg/kg to be given 2 hours before the procedure. The penicillin comes
in 250 mg/5 mL. How much of the medication will the nurse administer?
1. 2.5 mL.
2. 5 mL.
3. 10 mL.
4. 15 mL.
53. Which is the most common adverse reaction to erythromycin?
1. Weight gain.
2. Constipation.
3. Mouth sores.
4. Nausea and vomiting.
54. A child who weighs 20 kg is to receive 8 g of gamma globulin over 12 hours for
the treatment of idiopathic thrombocytopenia purpura. The concentration is 8 g in
300 mL of normal saline. How many milliliters per hour will the child receive?
1. 12 mL/hr.
2. 25 mL/hr.
3. 50 mL/hr.
4. 40 mL/hr.
55. The treatment for a child with sinus bradycardia is atropine 0.02 mg/kg/dose. How
much should the nurse give a child who weighs 20 kg?
1. 0.02 mg.
2. 0.04 mg.
3. 0.2 mg.
4. 0.4 mg.
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CHAPTER 14 PHARMACOLOGY
56. The effect of atropine is:
1. Anticholinergic.
2. As a beta-adrenergic agonist.
3. As a bronchodilator.
4. Sympathomimetic.
57. A common adverse reaction to atropine is:
1. Diarrhea.
2. Increased urine output.
3. No tears when crying.
4. Lethargy.
58. Which should the nurse include in teaching parents about administrating pancreatic
enzymes to their child?
1. The enzymes may be chewed or swallowed.
2. The capsules may be opened and sprinkled over acidic food.
3. Give the same amount of the medicine with meals and snacks.
4. Store the enzymes in the refrigerator.
59. Common side effects of oxybutynin (Ditropan) are:
1. Increase in heart rate and blood pressure.
2. Sodium retention and edema.
3. Constipation and dry mouth.
4. Insomnia and hyperactivity.
60. Ribavirin (Virazole) is prescribed for a hospitalized child with respiratory syncytial
virus (RSV). The nurse prepares to administer the medication by which route?
1. Oral.
2. Subcutaneous.
3. Intramuscular.
4. Oxygen tent.
61. A child has an infusion of dextrose 5% via a line with a volume control chamber on
the pump. The nurse knows this system is used for administration of intravenous
solutions for which reason?
1. Prevent accidental fluid overload.
2. Reduce the potential for bacterial infection.
3. Make administering of intravenous fluids easier.
4. Is less costly.
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Mix intravenous doses in normal saline as
mixtures precipitate with dextrose 5% in
water.
2. Phenytoin (Dilantin) should be given
slowly (1–2 mg/kg/min) via pump. Rapid
infusion may cause hypotension, arrhythmias, and circulatory collapse.
3. An inline filter is recommended.
4. Continuous monitoring of electrocardiogram, blood pressure, and respiratory status is essential because of potential side
effects.
TEST-TAKING HINT: The test taker must
know both the side effects of the drug and
how to administer it safely.
2. 1. This does not answer the parent’s question.
2. This is not a true statement as Advil is
enteric-coated, and not all ibuprofens are
enteric-coated.
3. This response answers the question and
tells the parent the physician is the only
one who can change a name brand to a
generic drug.
4. The nurse should not make that judgment.
The physician should be consulted.
TEST-TAKING HINT: The nurse needs to
answer the parent’s question and be aware
that a physician chooses name brand or
generic.
3. 1. Peak time for regular insulin is 2 to 3 hours.
2. Peak time for Semilente insulin is 4 to
7 hours.
3. Peak time for NPH insulin is 4 to
12 hours.
4. Peak time for Lente is 8 to 12 hours.
TEST-TAKING HINT: NPH insulin works in
an intermediate range; select an appropriate period.
4. 1. Giving morphine sulfate over 1 hour takes
too long to relieve the pain. It can be given
by slow intravenous push.
2. Because morphine sulfate can depress
respirations and the child has just had
abdominal surgery, deep breathing
should be encouraged.
272
3. Demerol (meperidine) is not used in children because of the risk of induced seizures.
4. One of the side effects of morphine sulfate
is itching, and Benadryl (diphenhydramine)
is a good medication to give as needed in
case of itching. It should not be given
together with the morphine sulfate.
TEST-TAKING HINT: The test taker must be
aware of the major side effects of morphine
and type of patient who is receiving the
morphine.
5. 1. Rifampin (Rifadin) causes an orange-red
discoloration of body fluids, including
urine. Knowledge of this can decrease
anxiety when it occurs.
2. Urinary retention is not a side effect.
Rifampin (Rifadin) is metabolized in the
liver and should be used with caution in
patients with elevated liver enzymes.
3. The drug is ordered prophylactically to
guard against developing meningitis.
4. The drug is given for 2 days as prophylactic
treatment.
TEST-TAKING HINT: Associate the “R” in
rifampin (Rifadin) with the red in orangered body fluids.
6. 1. Missed doses should be given as soon as
possible and not doubled with the next dose.
2. Doses of antibiotics should be taken at regular intervals over 24 hours without interrupting sleep to maintain maximum blood levels.
3. Attempting to have the child take it whole
could cause the child to aspirate.
4. A full course of the antibiotic must be
taken to decrease the risk of resistance
to the antibiotic or recurrence of the
infection.
TEST-TAKING HINT: The test taker must
know specific information about antibiotic
therapy.
7. 1. Liver damage is not associated with amphotericin therapy.
2. Serum levels of the drug are not done.
3. By giving the drug, there should not be a
change in sodium or protein levels.
4. The drug tends to be nephrotoxic. Elevation of blood urea, nitrogen, and creatinine levels indicates renal damage. If
elevated, the physician must be notified
to determine if the drug must be withheld for the day.
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CHAPTER 14 PHARMACOLOGY
TEST-TAKING HINT: This drug is nephrotoxic. Some nurses refer to the drug as
“amphoterrible.”
8. 1. Hepatic and neurological toxicities are
more common in fluoroquinolones.
2. Nephrotoxicity and ototoxicity are the
most significant adverse effects.
3. Myocardial toxicity is not a common
reaction.
4. Hepatic and neurological toxicities are
more common in fluoroquinolones
TEST-TAKING HINT: Aminoglycosides cause
kidney damage and loss of hearing. Levels
are checked before and after dosing so
that toxicity can be prevented.
9. 1. Vomiting is a side effect and is not related
to the rate of infusion.
2. Headache is not related to the rate of
infusion.
3. “Red man syndrome” or “red neck
syndrome” is flushing of the face, neck,
and upper chest associated with too
rapid an infusion of vancomycin. This
can be prevented with infusing the
vancomycin over 90 to 120 minutes
and pretreating the patient with Benadryl (diphenhydramine) prior to the
infusion.
4. Hypotension with shock can result from a
histamine release from rapid infusion.
TEST-TAKING HINT: “Red man syndrome”
is a side effect of too rapid an infusion of
vancomycin.
3. Central nervous system symptoms such
as confusion and psychosis are adverse
effects of steroids.
4. Gradual tapering of the dosages will prevent severe side effects, and no blood
work is required.
TEST-TAKING HINT: The test taker must
know about abrupt withdrawal of steroids
and the effects on the adrenal gland.
12. 1. The energy level takes much longer than
1 day to increase.
2. After starting therapy, peak levels of
the drug may not be expected for
many weeks to months. Patients need
to know this to prevent them from
stopping the medication because they
think it is not working.
3. The drug works best when taken on an
empty stomach; the patient should select
a time each day when the stomach is
empty. In children, just prior to bed may
be the best time, as most children do not
eat prior to bedtime.
4. The drug works best when taken on an
empty stomach. Taking it with milk
should be contraindicated.
TEST-TAKING HINT: Know the effects of
levothyroxine and how to administer it.
10. 1. This response does not answer the parents’ question.
2. Growth hormone is available as a parenteral medication and is given intramuscularly or subcutaneously.
3. Growth hormone is approved for use
only in children to treat a documented
lack of growth hormone.
4. The nurse must first answer the parents’
question about growth hormone.
TEST-TAKING HINT: Recall the reason for
giving growth hormone.
13. 1. The expected growth rate with growth
hormone therapy is 3 to 5 inches in
the first year.
2. Height and weight are measured monthly.
3. Growth hormone is discontinued when
optimum adult height is attained and fusion
of the epiphyseal plates has occurred.
4. Side effects include glucose intolerance,
hypothyroidism, adrenocorticotropic hormone deficiency, hypercalciuria, renal calculi, gastrointestinal upsets, and intracranial tumor growth.
TEST-TAKING HINT: Answer 2 is not correct
as “must” is too strong. Answer 4 states
“no side effects,” and this is unrealistic.
To choose the correct answer, the test
taker must rely on knowledge of growth
hormones.
11. 1. Abrupt withdrawal can cause severe side
effects.
2. Abrupt cessation of long-term steroid
therapy can cause acute adrenal insufficiency that could lead to death. Longterm steroid use can cause shrinkage of
the adrenal gland, which decreases the
production of the hormone.
14. 1. Humalog insulin is rapid-acting and
has an onset of 10 to 15 minutes.
2. Regular insulin has an onset of 30 minutes
to 1 hour
3. NPH insulin has an onset of 1 to 2 hours
and is intermediate-acting.
4. Ultralente insulin has an onset of 2 to
6 hours and is a long-acting insulin.
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TEST-TAKING HINT: Review the onset,
peak, and duration of all types of insulin.
15. 1. Metoclopramide (Reglan) is a gastrointestinal stimulant that increases
motility of the gastrointestinal tract,
shortens gastric emptying time, and
reduces the risk of the esophagus being exposed to gastric content.
2. Decreased tone in the esophageal
sphincter increases the risk of gastric
contents being regurgitated upward in
the esophagus.
3. There can be an increase in diarrhea because of the increase in gastrointestinal
motility.
4. Methyl scopolamine blocks effects of
acetylcholine and relaxes sooth muscles.
TEST-TAKING HINT: Gastroesophageal reflux disease results in backward flow of
gastric contents, so it is logical that a drug
prescribed should promote forward movement of gastric content.
16. 1. One of the side effects of high-dose
steroids can be diabetes mellitus. The
child needs to be evaluated so prompt
treatment can be initiated. The diabetes is self-limiting and after the
steroids are discontinued should no
longer be present. Other side effects
include mood changes, hirsutism,
trunk obesity, thin extremities, gastric
bleeding, poor wound healing, hypertension, immunosuppression, insomnia, and increased appetite.
2. This is not a side effect of steroids. Deep
vein thrombosis is related to clotting
abnormalities.
3. This is not a side effect of steroids.
4. This is not a side effect of steroids.
TEST-TAKING HINT: Review side effects of
high-dose steroid use.
17. 1. There should not be a change in potassium level, as the drug does not cause
potassium loss.
2. Hemorrhagic cystitis is a major side
effect of cyclophosphamide (Cytoxan);
checking the urine for blood is an
appropriate intervention.
3. Weights are obtained daily with clients
receiving chemotherapy because of nausea
and vomiting.
4. There are no central nervous system
side effects with cyclophosphamide
(Cytoxan).
TEST-TAKING HINT: Review major side
effects of cyclophosphamide.
18. 1. Mesna (Mesnex) is not a chemotherapeutic agent.
2. Mesna (Mesnex) does not prevent
arrhythmias.
3. Mesna (Mesnex) is a detoxifying agent
used as a protectant against hemorrhagic cystitis induced by ifosfamide
and cyclophosphamide (Cytoxin).
4. There is no medication that increases
absorption of chemotherapy.
TEST-TAKING HINT: Review the action of
mesna (Mesnex).
19. 1. Dalteparin sodium (Fragmin) is an anticoagulant used as prophylaxis for postoperative deep vein thrombosis.
2. Deferoxamine (Desferal) is an antidote
for acute iron toxicity.
3. Diclofenac (Voltaren) is an antiinflammatory drug.
4. Diltiazem (Cardizem) is an antianginal
agent for chronic stable angina.
TEST-TAKING HINT: Deferoxamine (Desferal)
is used to prevent iron overload.
20. 1. Chemotherapy may cause anemia, which
can compound the feeling of fatigue
rather than reduce fatigue.
2. The drug does not prevent infection, but it
does increase the number of neutrophils.
3. The drug may cause nausea and vomiting
rather than reduce it.
4. The drug mobilizes stem cells to produce neutrophils.
TEST-TAKING HINT: Recall the function of
the neutrophils and how to stimulate them.
21. 1. Immunizations can be given when the
child has a low-grade fever as long as the
child is not ill appearing.
2. Diagnose the problem before giving the
vaccine. Just giving the Tylenol would not
allow a diagnosis to be made, as it may
mask symptoms.
3. Immunizations can be given when the
child has a low-grade fever as long as
the child is not ill appearing.
4. The nurse would not want to give an
antibiotic until a bacterial infection was
diagnosed.
TEST-TAKING HINT: Immunizations should
not be given when a child has a high fever
and appears ill.
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CHAPTER 14 PHARMACOLOGY
22. 1. Lindane (Kwell) is the drug of choice
because it is well absorbed by the central nervous system of the parasite
(lice) and results in death.
2. Chlorhexidine (Hibiclens) is a skin
cleanser. Clean gloves, not sterile gloves,
should be used in treating lice.
3. Terbinafine (Lamisil) is an oral or nasal
antifungal agent for the treatment of tinea
infections.
4. Collagenase (Santyl) is an enzyme used in
skin débriding.
TEST-TAKING HINT: Associate the nature of
the parasite with the drug and application
method.
23. 1. The dose prescribed is too low.
Strep throat is treated with amoxicillin at
50 mg/kg/day. Convert pounds to kilograms by dividing by 2.2 (2.2 lb = 1 kg)
42 lb ÷ 2.2 = 19.09 kg
Dosing parameters:
50 mg/kg/day × 19.09 = 954.5 mg/day
Dosing frequency: 250 mg q8h =
750 mg/day
2. The dose prescribed is too low.
3. The dose is too low.
4. The dose is too low.
TEST-TAKING HINT: First change pounds
to kilograms. Calculate the ordered dose
using the formula given in the question.
Compare the order against the calculated
appropriate dose.
24. 1. 0.25 mg.
Convert pounds to kilograms by dividing
by 2.2 (2.2 lb = 1 kg)
16 lb ÷ 2.2 = 7.27 kg
Calculate the dosage by weight:
0.07 mg/day × 7.27 = 0.5 mg/day
Divide the dose by 2 because it is to be
given 2 times a day:
0.5 mg/day ÷ 2 doses = 0.25 mg for each
dose
2. Change the pounds to kilograms; the correct answer is 0.25 mg.
3. Change the pounds to kilograms; the correct answer is 0.25 mg.
4. Change the pounds to kilograms; the correct answer is 0.25 mg.
TEST-TAKING HINT: Change the pounds to
kilograms. The total amount is to be
given twice a day, so calculate each dose.
25. 1. The formula to determine the correct
answer is:
Desired over Available × Volume =
amount to be given
2. The formula to determine the correct
answer is:
Desired over Available × Volume =
amount to be given
3. Desired over Available × Volume =
amount to be given
300 mg/250 mg × 5 mL = 6 mL
4. The formula to determine the correct
answer is:
Desired over Available × Volume =
amount to be given
TEST-TAKING HINT: Use the formula to
determine the correct answer.
26. 1. Digoxin (Lanoxin) should not be taken
with food. Administer the medication
1 hour before or 2 hours after a meal.
2. The dose should not be repeated if the
child vomits.
3. The child’s pulse should be monitored
before each dose. The dose should be
withheld according to the physician’s
parameters.
4. Checking weight is not related to the
medication.
TEST-TAKING HINT: Know the principles
of giving digoxin (Lanoxin). Knowing that
the drug is given to decrease the heart
rate and increase cardiac output should
be a key to the answer involving checking
pulse.
27. 1. Salicylic acid is used in the treatment of
corns and warts.
2. Benzoyl peroxide inhibits growth of
Propionibacterium acnes (a gram-positive
microorganism). It is effective against
inflammatory and anti-inflammatory
acne.
3. Chlorhexidine (Hibiclense) is a cleaning
agent.
4. Collagenase (Santyl) is a débriding agent.
TEST-TAKING HINT: The test taker needs to
know the specific treatment for acne.
28. 1. The drug is not topical.
2. Hibiclens is a cleanser that can be drying
to the skin and so is not a good option.
3. It is mandatory to have a pregnancy
test done before starting treatment as
spontaneous abortions and/or fetal
abnormalities have been associated in
pregnancy with the use of isotretinoin
(Accutane).
4. Inflammation of the lips is a side effect of
isotretinoin (Accutane), but moisture will
not prevent the inflammation.
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TEST-TAKING HINT: Consider birth defects
associated with isotretinoin (Accutane).
29. 1. Dexamethasone (Decadron) is a corticosteroid used to decrease inflammation.
Spinal cord–related spasms are not caused
by inflammation.
2. Baclofen is used to treat the spasticity
in cerebral palsy. It is a centrally acting
muscle relaxant.
3. Diclofenac (Voltaren) is a nonsteroidal
anti-inflammatory drug.
4. Carbamazepine (Tegretol) is an antiepileptic used to treat seizures.
TEST-TAKING HINT: Spasticity affects the
muscles.
30. 1. The primary purpose of administrating
an opioid analgesic is to relieve pain.
The adverse effects that place the
child at greatest risk are respiratory
depression and decreased level of
consciousness.
2. Bowel sounds should be assessed because some opioids, such as morphine,
can decrease gastric motility, but this
is not as high a priority as is a decrease
in respirations.
3. Blood pressure could decrease and would
be assessed, but it is not as high a priority.
Decrease in blood pressure occurs after
decrease in respiratory effort.
4. Oxygen saturation will be decreased after
decrease in respiratory effort.
TEST-TAKING HINT: The critical word in
this question is priority. The test taker
should associate side effects from the
drug that have the highest priority and
will require nursing actions.
31. 1. Pull the pinna down and back for a child
younger than age 3 years.
2. Placing the cotton in the ear tightly
should be painful. The cotton could act as
a wick and not allow the medication to
absorb. It will not help in the administration of the eardrops.
3. Having the child stay in an upright position after instillation does not affect administration of the eardrops.
4. The correct way to administer eardrops
in a child older than 3 years of age is to
pull the pinna up and back, the same as
for an adult.
TEST-TAKING HINT: In infants, the ear canal
is curved upward; therefore, the pinna
should be pulled down and back. With children older than 3 years of age, the canal
curves downward and forward; therefore,
the pinna should be pulled up and back.
32. 1. Amoxicillin is given only orally, so the
order should be questioned.
2. The dose cannot be given because the
route is incorrect.
3. The dosing frequency is correct.
4. There is not enough information to determine if the dose is correct.
TEST-TAKING HINT: Focus on the route,
dose, and frequency when administrating
a medication.
33. 1.
2.
3.
4.
This is correct, but it is not done first.
This is correct, but it is not done first.
This is correct, but it is not done first.
The procedure for instilling eye ointment begins with washing hands followed by donning clean gloves.
TEST-TAKING HINT: The key word in the
question is first. Washing hands has the
highest priority.
34. 1. The medication should not be shared
because of the risk of spreading the infection to another family member.
2. The medication should be given only as
prescribed. More frequent use could cause
adverse reactions.
3. Inserting the dropper as far back as possible into the nasal canal could cause injury
to the child.
4. Medications should not be saved for future
illness, as the drug may not be appropriate.
TEST-TAKING HINT: The test taker must
have specific knowledge of instillation of
nasal drops.
35. 1. Trimethoprim/sulfamethoxazole (Septra)
should be given on an empty stomach.
2. Trimethoprim/sulfamethoxazole (Septra)
should be given on an empty stomach.
3. Trimethoprim/sulfamethoxazole (Septra) should be administered with a full
glass of water on an empty stomach. If
nausea and vomiting occur, giving the
drug with food may decrease gastric
distress.
4. Carbonated beverages should be avoided
because they may irritate the bladder.
TEST-TAKING HINT: The test taker must
know how to administer trimethoprim/
sulfamethoxazole (Septra).
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36. 1. First convert pounds to kilograms. The
correct answer is 20 g.
2. Convert pounds to kilograms: 2.2 lb =
1 kg
Divide 22 pounds by 2.2
22 lb. ÷ 2.2 kg = 10 kg
Calculate the dose:
2 g/kg = 2 g × 10 kg = 20 g
3. First convert pounds to kilograms. The
correct answer is 20 g.
4. First convert pounds to kilograms. The
correct answer is 20 g.
TEST-TAKING HINT: Convert pounds to
kilograms before starting any calculations.
37. 1. Hypertension is not associated with lindane
(Kwell).
2. Lindane (Kwell) with topical use is associated with seizures after absorption.
3. Lindane (Kwell) is not associated with
elevated liver functions.
4. Lindane (Kwell) does not cause alopecia.
TEST-TAKING HINT: Lindane (Kwell) is
used as a second-line treatment for lice.
Be aware of the reasons it should not be
used a second time.
38. 1. Common adverse effects are headaches
and abdominal complaints.
2. Pyrantel pamoate (Antiminth) is effective
against adult worms, and additional
treatment is needed to kill the emerging
parasites.
3. Pyrantel pamoate (Antiminth) may color
the urine a reddish color.
4. As the first treatment kills the adult
worms, a second treatment is done in
2 weeks to treat emerging parasites.
TEST-TAKING HINT: Review medications
used to treat pinworms and how they are
administered.
39. 1. Hydrocortisone cream should be used
for brief periods because it can thin
the skin and cause skin breakdown.
2. Higher concentrations of hydrocortisone
are contraindicated.
3. The drug does not lose its efficacy.
4. An antibiotic is inappropriate for the
treatment of eczema.
TEST-TAKING HINT: Focus on the concentration of the hydrocortisone and the
effects on the skin.
40. 1. Incorrect calculation.
2. The dose is calculated by multiplying
the weight by the milligrams. That
result is divided by two doses. The
milligrams are then used to determine
the milliliters based on the concentration of the drug.
40 mg × 15 kg = 600 mg/2 doses =
300 mg/dose
The concentration of the drug is 250 mg/
5 mL. Use the formula Desired over
Available times Volume to get the mL
per dose.
300 mg/250 mg × 5 mL = 6 mL
3. Incorrect calculation.
4. Incorrect calculation.
TEST-TAKING HINT: Identify the key components of the question.
41. 1. First convert pounds to kilograms; multiplying by 5 mg by weight gives the
amount of milligrams per 24 hours.
2. First convert pounds to kilograms; multiplying by 5 mg by weight gives the
amount of milligrams per 24 hours.
3. First convert 40 pounds to kilograms
by dividing the pounds by 2.2 (2.2 lb =
1 kg)
40 ÷ 2.2 = 18.18 kg
Multiplying 5 mg by the weight (18.18)
gives the amount of milligrams for 24 hours
18.18 kg × 5 mg = 90.9 mg/day
Divide the total milligrams (90.9 mg) by
4, as that is the number of doses
90.9 mg ÷ 4 = 22.75 mg per dose
4. First convert pounds to kilograms; multiplying 5 mg by weight gives the amount
of milligrams per 24 hours.
TEST-TAKING HINT: Convert pounds to
kilograms, and then identify the key components needed to determine the answer.
42. 1. The onset of Lasix is 20 to 60 minutes.
It peaks at 60 to 70 minutes, with a
duration of 2 hours. By 24 hours, 50%
is eliminated. Because the child may
not respond as expected, the mother
should be instructed to give the Lasix
at 8:00 a.m. to avoid interruption of
sleep with frequent urination.
2. Noon is more appropriate than 6:00 p.m.
and bedtime.
3. Because 50% remains in the body, a cumulative effect could disrupt the child’s
sleep-rest pattern.
4. An onset of 20 to 60 minutes results in a
direct interruption of the sleep-rest pattern.
TEST-TAKING HINT: Knowledge of pharmacokinetics is necessary to determine the
best time to administer Lasix. Knowing
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the drug is a diuretic assists in determining a time that avoids disrupting the
sleep-rest pattern.
43. 1. The symptoms of an acute asthma attack are related to constriction of the
airway, which leads to dyspnea and
an increased respiratory rate. The albuterol (Proventil) is a beta-adrenergic
agent that relaxes the smooth muscles
of the bronchial tree, which will decrease the wheezing.
2. The respiratory rate should return to normal. A rate of 34 is considered high.
3. Hypertension is a side effect of albuterol
(Proventil).
4. Tachycardia is a side effect of albuterol
(Proventil).
TEST-TAKING HINT: The test taker must
know the primary outcome of the drug
action.
44. 1. One side effect of albuterol (Proventil) is
tachycardia, not bradycardia.
2. Decreased blood pressure is not expected. Dizziness may occur from the
tachycardia.
3. Potential side effects of this medication are stimulation of the central
nervous system and cardiovascular system. Tachycardia is the most frequent
side effect of albuterol (Proventil).
4. Increased blood pressure can occur, but
the child will not experience lethargy until exhausted, which is a later effect.
TEST-TAKING HINT: Albuterol (Proventil)
has a major side effect of tachycardia,
which worsens with increased doses.
45. 1. The antibiotic should be given every
6 hours to maintain blood levels. This
schedule means that the antibiotic would
be given every 4 hours during the day,
with 12 hours between the last night dose
and the first morning dose.
2. Antibiotics should be scheduled to
maintain therapeutic blood levels and
not interfere with the child’s sleep.
This schedule allows for dosing every
6 hours during the day and allows the
child to get 7 hours of uninterrupted
sleep at night.
3. This is basically the same interval of dosing as answer 1.
4. This is the same interval of dosing as answers 1 and 2.
TEST-TAKING HINT: Determine the best
timing to maintain therapeutic drug levels
and allow the patient to rest.
46. 1. The upper thigh is used for subcutaneous
and intramuscular injections.
2. The scapular area and back are used for
allergy skin testing.
3. The scapular area and back are used for
allergy skin testing.
4. The ventral forearm is the preferred
site for the tuberculin skin test.
TEST-TAKING HINT: The test taker must
know sites of administration of medications in children.
47. 1. Desired over Available × Volume =
Desired dose
75 mg/80 mg × 0.8 mL = 0.75 mL
2. Desired over Available × Volume =
Desired dose.
3. Desired over Available × Volume =
Desired dose.
4. Desired over Available × Volume =
Desired dose.
TEST-TAKING HINT: The test taker must
know the correct formula and then use
the information in the question to determine the answer.
48. 1. Weight gain is not a toxic reaction.
2. Bradycardia is a side effect. Tachycardia is
not a reaction.
3. Digoxin (Lanoxin) toxicity in infants
and children may present with nausea,
vomiting, anorexia, or a slow, irregular,
apical heart rate.
4. Seizures are not a toxic reaction that
occur with digoxin (Lanoxin).
TEST-TAKING HINT: The test taker must
know common toxic effects of digoxin
(Lanoxin), which is used frequently in
children with heart defects.
49. 1. Use the child’s weight × 10 mcg = the
amount per kilogram per day. But this
total amount is to be divided by 2 to
determine the amount per dose.
2. 10 kg × 10 mcg/kg/day = 100 mcg ÷
2 doses a day = 50 mcg/dose.
3. Use the child’s weight × 10 mcg = the
amount per kilogram per day. But this total amount is to be divided by 2 to determine the amount per dose.
4. Use the child’s weight × 10 mcg = the
amount per kilogram per day. But this
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CHAPTER 14 PHARMACOLOGY
total amount is to be divided by 2 to determine the amount per dose.
TEST-TAKING HINT: The test taker must
know the correct formula to use.
50. 1. Preterm neonates with good renal
function may receive indomethacin, a
prostaglandin inhibitor, to encourage
patent ductus arteriosus closure.
2. Hypertension is a side effect of
indomethacin.
3. A prostaglandin inhibitor does not affect
surfactant in the lungs.
4. The drug may cause nephrotoxicity.
TEST-TAKING HINT: Apply pathophysiology
of the preterm neonate to the drug.
51. 1. Digoxin (Lanoxin) is given to treat congestive heart failure.
2. Antibiotics are used if there is an infection and prophylactically with invasive
procedures.
3. Prostaglandin E is necessary to maintain patency of the patent ductus arteriosus and improve systemic arterial
flow in children with inadequate intracardiac mixing.
4. Diuretics are given to treat congestive
heart failure.
TEST-TAKING HINT: The test taker must
know the pathophysiology of the defect,
and determine the most important treatment to improve cardiac function.
52. 1. Determine the child’s weight in kilograms;
then multiply the child’s weight by 25 mg.
2. Determine the child’s weight in kilograms; then multiply the child’s weight by
25 mg.
3. Determine the child’s weight in kilograms by dividing 44 lb by 2.2 (2.2 lb =
1 kg). Then determine how many milligrams need to be given by multiplying the child’s weight in kilograms by
25 mg.
44 lb ÷ 2.2 kg = 20 kg
20 kg × 25 mg = 500 mg
Use the formula Desired over Available ×
Volume = Desired dose
500 mg/250 mg × 5 mL = 10 mL
4. Determine the child’s weight in kilograms; then multiply the child’s weight by
25 mg.
TEST-TAKING HINT: The test taker must
know the correct formula to use.
53. 1. Weight gain is not a side effect of
erythromycin.
2. Diarrhea, not constipation, is an adverse
reaction to erythromycin.
3. Mouth sores are not an adverse reaction.
4. Common adverse reactions to erythromycin include nausea, vomiting, diarrhea, abdominal pain, and anorexia.
Erythromycin should be given with a
full glass of water and after meals.
Because these gastrointestinal adverse reactions occur commonly, it
may be necessary to give erythromycin with food.
TEST-TAKING HINT: The test taker must
know the major side effects of this drug
are gastrointestinal.
54. 1. Take the total volume and divide it by the
number of hours.
2. Take the total volume (300 mL) and
divide it by the number of hours
(12 hours)
300 mL ÷ 12 hours = 25 mL/hr
3. Take the total volume and divide it by the
number of hours.
4. Take the total volume and divide it by the
number of hours.
TEST-TAKING HINT: The test taker must
know the correct formula to use.
55. 1. Take the dose of atropine times the child’s
weight in kilograms.
2. Take the dose of atropine times the child’s
weight in kilograms.
3. Take the dose of atropine times the child’s
weight in kilograms.
4. Take the dose of atropine (0.02 mg/kg)
times the child’s weight (20 kg)
0.02 mg/kg × 20 kg = 0.4 mg
TEST-TAKING HINT: Atropine is a medication given during a code situation, so the
test taker must know how to calculate the
dosing.
56. 1. Atropine is an anticholinergic drug.
It blocks vagal impulses to the myocardium and stimulates the cardioinhibitory center in the medulla. It
increases heart rate and cardiac output.
2. This is not the classification of atropine.
3. This is not the classification of atropine.
4. This is not the classification of atropine.
TEST-TAKING HINT: The test taker must
know the classification of major drugs.
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57. 1. There should be constipation, rather than
diarrhea, because of decrease in smooth
muscle contraction of the gastrointestinal
tract.
2. There should be urinary retention due to
decrease in smooth muscle contractions of
the gastrourinary tract.
3. Atropine dries up secretions and also
lessens the response of ciliary and iris
sphincter muscles in the eye, causing
mydriasis.
4. Atropine usually causes paradoxical excitement in children, so lethargy should
not occur.
TEST-TAKING HINT: The test taker must
know the side effects based on the action
of the drug.
58. 1. The enzymes must be swallowed whole.
Retention in the mouth may cause mucosal irritation and stomatitis.
2. When administrating enzymes to infants, the capsule may be opened and
sprinkled over an acidic food, such as
applesauce or mashed fruit.
3. The child should take the same amount of
enzymes with each meal and half the dose
with each snack.
4. There is no need to refrigerate the
medication.
TEST-TAKING HINT: By knowing that enzymes are capsules, the test taker should
eliminate answer 1, as capsules are not
chewed.
59. 1. There may be tachycardia but no
hypertension.
2. There is no sodium retention, so there
will be no edema.
3. Common side effects are constipation
and dry mouth as the oxybutynin
(Ditropan) has an atropine-like effect.
4. Adverse effects from overdose may have
some central nervous system effects such
as nervousness that cause insomnia and
hyperactivity.
TEST-TAKING HINT: Oxybutynin (Ditropan)
has an atropine-like effect that causes
vasoconstriction symptoms.
60. 1. Ribavirin (Virazole) is not given orally.
2. Ribavirin (Virazole) is not given
subcutaneously.
3. Ribavirin (Virazole) is not given
intramuscularly.
4. Ribavirin (Virazole) is an antiviral respiratory medication used in the hospital for children with severe respiratory
syncytial virus. Administration is via
hood, face mask, or oxygen tent.
TEST-TAKING HINT: The test taker must
know that this medication is aerosolized.
61. 1. The volume control chamber functions as a safety device. No more than
2 hours of solution is placed in the
chamber at a time. If the pump should
be programmed incorrectly, the child
would get only 2 hours of fluids; then
the pump would alarm. The nurse is
thereby alerted that the pump was
programmed incorrectly.
2. This is not a measure to prevent infection.
3. The rationale for using a particular
protocol for administration of intravenous fluids should not be based on
conveniences for the nurse, but rather
on safety.
4. This is more costly because it requires
additional or different tubing.
TEST-TAKING HINT: The test taker must
know safety issues for administration of
intravenous fluids with children.
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Comprehensive
Exam
15
QUESTIONS
1. Which outcome is expected in a breastfed newborn?
1. Voids spontaneously within 12 hours of life.
2. Loses 10% of body weight in the first 5 days.
3. Regains birth weight by the 14th day of life.
4. Awakens spontaneously for all feedings.
2. The average newborn weighs 3400 g. The nurse will tell the parents that the baby
weighs ______________________ lb.
3. The posture of a healthy term newborn is described as:
1. Hypotonic.
2. Asymmetric.
3. Extended.
4. Flexed.
4. The nurse is working in the newborn nursery and accidentally bumps the crib of one
of the babies. This baby demonstrates a Moro reflex. The nurse sees this baby in
which posture?
1. Trunk extended upward and head lifted.
2. When placed on abdomen, crawling movement occurs.
3. A “fencing” posture.
4. Extremities extended and abducted and fingers fanned.
5. The parent of a newborn wants to know what the newborn screening test does. What
is the nurse’s best response?
1. “It detects a large number of congenital diseases.”
2. “It screens for phenylketonuria and hypothyroidism.”
3. “Parents choose which diseases to screen for.”
4. “Screens for congenital diseases that insurance companies cover.”
6. A family is adopting a 3-year-old child from Russia. What suggestions can be given to
the parents for incorporating the child into the family? Select all that apply.
1. Learn as much about the child as possible before adoption.
2. Expect conflict and determine how to work through it with the child.
3. Do not discuss the biological parents with the child.
4. Discuss your expectations with the child.
5. Try to maintain a part of the child’s original family name.
7. When the parents of a 5-year-old tell the child they are divorcing, the parents need to
be aware of behaviors that the child may demonstrate. Select all that apply.
1. Increased self-esteem, bragging.
2. Changes in sleep and appetite.
3. Feelings of abandonment.
4. Develops dictatorial attitude.
5. Verbalizes feelings about divorce-related changes.
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8. The mother of a 6-month-old is going back to work. The nurse should make which
of the following suggestions for ways to evaluate day-care options? Select all that
apply.
1. Size of day-care center.
2. Strict health and safety requirements.
3. Caretakers who are loving and kind.
4. Challenging activities for all the children.
5. Child-care ratios that maximize staff use.
6. Small class size.
9. Match each genetic term with its definition and function.
1. Congenital
A. Morphogenic defect of an organ
2. FISH analysis
B. Recognized pattern of malformation
3. Genome
C. Present at birth
4. Malformation
D. Clinically exhibited characteristic
5. Phenotype
E. Fluorescent in situ hybridization
6. Syndrome
F. Complete genetic information of organism
10. Parents are concerned that their pediatrician suspects Turner syndrome in their
newborn. Which physical characteristics lead to this suspicion?
1. Cleft lip and palate.
2. Weak, high-pitched cry.
3. Webbed neck and lymphedema.
4. Long arms and small genitalia.
11. A pregnant teen is to have prenatal testing. She is afraid of needles and wants to
know the least invasive way she can get the testing done. The nurse should suggest
which testing procedure?
1. Triple marker screen.
2. Ultrasound examination.
3. Amniocentesis.
4. Chorionic villus sampling.
12. Parents are told by the genetic counselor that they have a 1:4 probability of having a
second child with cystic fibrosis (CF). They already have one child who is affected.
The parents state their risk is lower now than when they had the previous child.
What should the nurse tell the parents about the 1:4 probability?
1. Each pregnancy is an independent event.
2. The probability of having another child with CF is twice as likely as it was when
they had the first child.
3. The probability of having a healthy child is twice as likely with this pregnancy.
4. The probability of miscarrying is greater now than with the previous pregnancy.
13. A young woman tells a nurse she is pregnant and concerned that her boyfriend may
be “slow” mentally. The nurse should do which activity first?
1. Develop a pedigree.
2. Take a family history.
3. Inform the provider about the concern.
4. Refer the client for genetic counseling.
14. A parent who is Jehovah’s Witness has a child with leukemia and a very low RBC
count. The nurse should recognize that the family faces which dilemma?
1. Numerous dietary kosher laws exist.
2. A belief that only Allah cures illness.
3. Desire for anointing of the sick.
4. Opposition to transfusions and vaccines.
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CHAPTER 15 COMPREHENSIVE EXAM
15. Many families are first-generation Americans and have many beliefs about health that
were learned in their native countries. Match the culture with the health-care belief.
1. Haitians
A. Religion and medicine strongly interwoven
2. Cubans
B. Nutrition is important in good health
3. Arabs
C. Illness has a supernatural origin (voodoo)
4. Chinese
D. Believe hot-cold theory of illness
5. Native Americans
E. Illness caused by the “evil eye”
16. The nurse is working in a clinic, and the next patient is an infant with deaf parents.
In addition to providing an interpreter for the deaf, the nurse should incorporate
what additional aid in communicating with the family?
1. Talk just as with hearing families.
2. Maintain good eye contact to let them read the nurse’s lips.
3. Explain procedures thoroughly.
4. Recommend a trained hearing dog.
17. A teenager is legally blind. The teen is wearing thick glasses and is carrying some
schoolbooks. Which question should the nurse ask the teen?
1. “Just how blind are you?”
2. “Can you see enough to read those books?”
3. “Tell me what you can see in this room.”
4. “Is your vision worse than 20/200 in either of your eyes?”
18. The nurse is working in a school health clinic, and a child comes in complaining of
“something in my eye.” What should the nurse do first?
1. Have the child wash hands.
2. Refer the child to an ophthalmologist.
3. Wash out the affected eye with tap water.
4. Examine the eye for a foreign body.
19. A child assigned to the nurse’s floor has a dysfluency. The nurse should recognize
what symptoms?
1. Stuttering.
2. Substitution of one sound for another.
3. Speaking in a monotone.
4. Hypernasal speech.
20. Parents confide to the nurse that their child, who is 35 months old, does not talk and
spends hours sitting on the floor watching the ceiling fan go around. They are concerned their child may have autism. The nurse should ask the parents which question?
1. “Does your child have brothers or sisters?”
2. “Does your child seek you out for comfort and love?”
3. “Do you have trouble getting babysitters for your child?”
4. “Does your child receive speech therapy?”
21. The nurse in the emergency department is caring for an 8-month-old who suffered a
concussion from an automobile accident. The infant was in the car seat at the time.
The nurse should assess the infant for which symptoms?
1. Sweating, irritability, and pallor.
2. Plethora and hyperthermia.
3. Crying with fear.
4. Negative Babinski reflex.
22. A parent tells the nurse that the 3-month-old infant is fussy, spits up constantly, and
has a lot of gas, and that there is a family history of allergies. These symptoms are
related to which diagnosis?
1. Failure to thrive.
2. Sensitive to cow’s milk.
3. Phenylketonuria.
4. Pancreatic insufficiency.
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23. The nurse on the previous shift charted that a newborn demonstrated cutis marmorata.
The nurse now caring for the baby should check which vital sign?
1. Blood pressure.
2. Respirations.
3. Skin color.
4. Temperature.
24. The nurse is caring for a newborn with Erb palsy and a phrenic nerve paralysis.
The most effective way to promote respiratory effort is for the nurse to position the
newborn in what way?
1. Supine.
2. On the affected side.
3. On the unaffected side.
4. Prone.
25. A 2-day-old baby is being readied for discharge but looks jaundiced. The nurse reviews
the baby’s birth records and notes that the baby has A blood type, and the mother has
O blood type. The nurse should check which blood test?
1. Hepatitis B titer.
2. Total bilirubin.
3. Complete blood count.
4. Sedimentation rate.
26. An infant at 12 hours of age has a positive Coombs test result and a bilirubin level of
18 mg/dL. The provider has ordered an exchange transfusion for the infant. As the
transfusion is proceeding, the nurse should watch for which sign?
1. Increasing jaundice.
2. Lethargy.
3. Temperature instability.
4. Irritability.
27. A baby is brought into the clinic for follow-up review of phenylketonuria. The
baby is 9 months old and weighs 22 lb. If the recommendation is to limit the
phenylalanine in the diet to 25 mg/kg/day, this infant should have no more than
______________________ of phenylalanine/day.
28. The nurse working in the newborn nursery has to draw a heel-stick blood sample
before an infant’s discharge. What can the nurse do to decrease the pain the infant
feels from this procedure? Select all that apply.
1. Wrap the heel in a warm, damp cloth.
2. Use EMLA before doing the stick.
3. Swaddle the infant.
4. Have the infant do non-nutritive sucking.
5. Do the stick while the infant is asleep.
29. The nurse’s unit is using the POPS pain scale for measuring pain in infants. The
nurse knows this tool is which of the following?
1. Pain Assessment Tool for infants 27 weeks to term gestation.
2. The Neonatal Infant Pain Scale for infants 3 to 12 months.
3. Premature Infant Pain Profile for infants 32 weeks to term gestation.
4. Post-Operative Pain Score for infants 1 to 7 months.
30. The nurse tells a parent which of the following data can be provided by a
polysomnogram? Select all that apply.
1. Heart rate and respirations.
2. Brain waves.
3. Eye and body movements.
4. Cyanosis or plethora.
5. End-tidal carbon dioxide.
31. Parents tell the nurse that their 18-month-old is always curious about the environment and is learning new words every day. The toddler is entering a phase of rapid
______________________development.
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CHAPTER 15 COMPREHENSIVE EXAM
32. Parents are concerned that their toddler refuses to sleep in the new toddler bed and
wonder what to do. The nurse explains that the child is using “global organization.”
What does the nurse mean by this term?
1. “The pre-operational phase of developing cognitive thought starts around 3 years old.”
2. “The child is self-centered and does not want to learn.”
3. “The child sees changing to a toddler bed as changing the whole process of sleeping
and going to bed.”
4. “The toddler may have a phobia to the bed.”
33. Parents express concern that their 5-year-old has started having more temper
tantrums. The parents want to know if this is normal for this age. What should the
nurse ask the parents about the tantrums? Select all that apply.
1. “Do you notice and praise your child when your child does something right?”
2. “Are the tantrums related to one specific aspect of life?”
3. “Are the tantrums causing any harm to self or others?”
4. “Have you consulted the Internet for any suggestions?”
5. “How do you handle your child during a tantrum?”
34. Parents are told they should start taking their toddler to the dentist. They are concerned their child is too young and that the dentist will be too harsh with the child.
The nurse suggests the parents do which of the following before the dental visit?
1. Tell the child it will not hurt.
2. Warn that they will have the dentist give a needle in case of bad behavior.
3. Tell the child they will go along to the dentist so that they can model comfortable,
safe behavior.
4. Offer the child a treat for good behavior.
35. A 17-month-old is brought into the clinic, and the nurse notes the toddler has tooth
decay on the maxillary upper incisors. Which tactic(s) would the nurse suggest to
wean the toddler from the bottle? Select all that apply.
1. Hide the bottle and tell the toddler that it is not needed anymore.
2. Put only tap water in the bottle.
3. Give the bottle only at night.
4. Give the toddler a pacifier and take the bottle away.
5. Do not give any bottles before bed.
36. Parents are frustrated with toilet-training their 2-year-old. Both parents work fulltime and claim they do not have time to spend on toilet-training. What suggestions
can the nurse give the parents to decrease their frustration?
1. “You will have to invest some time if the child is to be toilet-trained.”
2. “A child needs to be both physically and psychologically ready to learn the skills
needed to be continent.”
3. “Do you think your child is stubborn?”
4. “Have the child sit on the toilet until the child voids.”
37. Parents are interested in switching their child from a booster seat to a regular seat
belt. The child is 7 years old and weighs 51 lb. What can the nurse tell the parents
about switching the child to a seat belt? Select all that apply.
1. The safest place to ride in the car is in the front seat.
2. The child needs to weigh 60 lb and be 8 years old to qualify legally for a seat belt.
3. The seat belt should be worn low on the hips.
4. Use a shoulder belt only if it does not cross the child’s neck.
5. Tether straps are optional.
38. The nurse goes to the kindergarten classroom to evaluate a rash. A 5-year-old has patches
of itchy vesicles on the chest and face. The teacher tells the nurse the child had a runny
nose a couple of days ago. The nurse suspects that the rash is caused by which virus?
1. Fifth disease (Parvovirus B19).
2. Roseola (Herpesvirus type 6).
3. Scarlet fever (group A beta-hemolytic streptococcus).
4. Chickenpox (varicella zoster).
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39. The clinic is doing a lead screening program for children in a low-income Hispanic
community. The nurse working in the program wants to tell the parents the reasons
to have their children screened for lead poisoning. Select all that apply.
1. Young children absorb 10% of the lead to which they are exposed.
2. Homes built between 1900 and 1950 may contain lead-based paint.
3. The blood level of lead should be below12.8 mcg/dL.
4. Lead can affect any part of the body, but the brain and kidneys are at greatest risk.
5. Foods such as fruit, candy, and antacids contain lead.
40. A 9-year-old boy is brought to the clinic for a physical. The child’s weight is 95 lb
(95th percentile), and the height is 4 feet 4 inches (50th percentile). Blood pressure is
118/75. Reading the blood pressure graph in the following figure, the boy is in the
______________________ percentile for systolic and in the ______________________
percentile for diastolic readings for his age.
Blood Pressure Levels for Boys by Age and Height Percentile
Age
(year)
HP
Percentile
1
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
50th
90th
95th
99th
2
3
4
5
6
7
8
9
10
Systolic BP (mmHg)
Percentile of Height
Diastolic BP (mmHg)
Percentile of Height
5th 10th 25th 50th 75th 80th 95th
60
94
98
105
84
97
101
109
86
100
104
111
88
107
106
113
90
104
106
115
91
105
109
116
93
106
110
117
94
107
111
119
95
109
113
120
97
111
115
122
61
95
99
106
85
89
102
110
87
101
105
112
89
103
107
114
91
105
109
116
92
106
110
117
94
107
111
118
95
109
117
120
96
110
114
121
98
112
116
123
63
97
101
108
87
100
104
111
89
103
107
114
91
105
109
116
93
106
110
118
94
109
112
119
95
109
113
120
97
110
114
122
88
112
116
123
100
114
117
125
65
99
103
110
88
102
105
113
91
105
109
116
93
107
111
118
95
108
112
120
95
110
114
121
97
111
115
122
99
112
116
123
100
114
116
125
102
115
119
127
87
100
104
112
88
102
105
113
91
105
109
116
93
107
111
118
85
108
112
120
98
110
114
121
97
111
115
122
99
112
116
123
100
114
116
125
102
115
119
127
88
102
106
113
92
106
109
117
94
108
112
110
96
110
114
121
98
111
115
123
99
113
117
125
100
114
118
125
102
115
119
127
103
117
121
128
105
119
122
130
89
103
106
114
92
106
110
117
95
109
113
120
97
111
115
122
98
112
116
123
100
113
117
125
101
115
119
126
102
116
120
127
104
118
121
129
106
119
123
130
5th 10th 25th 50th 75th 80th 95th
34
40
54
61
39
54
59
66
44
59
63
71
47
62
66
74
50
65
69
77
53
66
72
80
55
70
74
82
56
71
76
83
57
72
76
81
50
73
77
85
35
50
54
62
40
55
59
67
44
59
63
71
48
63
67
76
51
66
70
78
53
68
72
80
55
70
74
82
57
72
76
84
58
73
77
85
59
73
78
86
36
51
55
63
41
56
60
63
45
60
64
72
49
64
68
76
52
67
71
79
54
69
73
81
66
71
75
83
63
72
77
83
60
74
78
88
60
74
79
86
37
52
54
64
42
57
61
69
48
61
65
73
50
65
69
77
53
68
72
80
55
70
74
82
57
72
76
84
60
73
78
86
60
75
79
87
61
75
80
88
35
53
57
65
43
58
62
70
47
62
66
74
51
66
70
78
54
69
73
81
56
71
75
83
58
73
77
85
60
74
79
87
61
76
80
88
61
76
81
88
39
53
58
66
44
58
63
71
46
63
67
76
51
66
71
78
55
60
74
81
57
72
76
84
69
74
78
86
60
76
79
87
61
76
81
88
62
77
81
89
39
54
58
66
44
59
63
71
48
63
67
76
52
67
71
79
55
70
74
82
57
72
76
84
59
74
78
86
61
76
80
88
62
77
81
89
63
78
82
90
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CHAPTER 15 COMPREHENSIVE EXAM
287
41. The nurse is working in a school health clinic, and a teen mentions that her older
sister just had a baby born with a myelomeningocele. The teen is wondering if there
is anything she can do to prevent this from happening to her baby when she decides
to have children. Which is the best response?
1. Take a multivitamin with folic acid daily.
2. Eat more fruits and vegetables daily.
3. Have breakfast every morning.
4. There is nothing that can be done to decrease the risk.
42. A 16-year-old comes into the clinic for a physical examination. The teen weighs 180 lb
and is 5 feet 5 inches tall. According to the following figure, the teen’s body mass index
(BMI) is ______________________.
Body Mass Index Table
Normal
Overweight
Obese
Extreme Obese
BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Height
(inches)
91
58
96 100 106 110 115 112 124 129 134 138 143 145 153 155 162 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258
Body Weight (pounds)
59
94
99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 196 203 208 212 217 222 227 232 237 242 247 252 257 262 267
60
97 102 107 112 118 123 128 133 138 143 148 153 155 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276
61
100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 286
62
104 109 115 120 129 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295
63
107 113 118 124 130 135 141 148 152 158 163 169 175 180 186 191 197 203 205 214 220 225 231 237 242 248 254 259 266 270 278 282 287 293 299 304
64
110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314
65
114 120 126 132 136 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324
66
118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334
67
121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344
68
125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 252 269 276 282 289 295 302 308 315 322 328 335 341 348 354
69
128 135 142 147 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365
70
132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376
71
138 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 266 272 279 286 293 301 308 315 322 329 338 343 351 358 366 372 379 386
72
140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397
73
144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408
74
148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 331 342 350 358 365 373 381 389 396 404 412 420
75
152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431
76
155 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 386 394 402 410 418 426 435 443
43. A 12-year-old girl with a thoracic myelomeningocele has had numerous urinary
tract infections and has difficulty doing her clean intermittent self-catheterization.
She and her parents are seeking an alternative way to empty her bladder. The
surgeon has offered to do a Mitrofanoff procedure. The surgeon will use the
______________________ to create a continent conduit between the bladder and
the abdominal wall.
44. The parent of a school-aged child who is a paraplegic and uses a wheelchair states
that the child is allergic to latex. Which is the most important intervention for this
child?
1. Giving antihistamines and steroids after procedures.
2. Prevention of contact with latex products.
3. Doing a radioallergosorbent test before each procedure.
4. Using only latex-free gloves when doing procedures.
45. A 5-month-old with a lumbar myelomeningocele is admitted to the unit with an
Arnold-Chiari malformation. The infant has which other diagnosis?
1. Hydrocephalus.
2. Anencephaly.
3. Tethering of the spinal cord.
4. Perinatal hemorrhage.
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46. Which would the nurse assess in a 4-week-old infant who has developmental dysplasia
of the hip and is wearing a Pavlik harness?
1. Diaper dermatitis.
2. Talipes equinovarus.
3. Leg shortening and limited abduction.
4. Pain.
47. Which is the primary goal for a newborn with a cleft of the soft palate?
1. Prevent ear infections.
2. Help the mother bond with the baby.
3. Repair the cleft palate.
4. Establish feeding and sucking.
48. When an infant is born with a herniation of the abdominal wall with intestine present
and the peritoneal sac absent, it is called ______________________.
49. What are the two organizations in the United States that make and govern the
recommendations for immunization policies and procedures?
1. National Advisory Committee on Immunization and American Medical Association.
2. U.S. Public Health Service Centers for Disease Control and American Academy
of Pediatrics.
3. National Immunization Program and Pediatric Infectious Disease Association.
4. National Institutes of Health and Minister of National Health and Welfare.
50. A nurse is working in a well-child clinic administering immunizations to preschoolers.
Which procedure will minimize local reactions to the injections?
1. Apply EMLA cream 1 hour before.
2. Change the needle on the syringe after drawing up the biological drug.
3. Inject into the vastus lateralis or ventrogluteal muscle.
4. Use distraction such as telling the child to hold the breath.
51. A fixed splitting of the S2 heart sound is heard in an otherwise healthy child. This is a
diagnostic sign of which cardiac defect?
1. Mitral regurgitation.
2. Atrial septal defect.
3. Functional murmur.
4. Pericardial friction rub.
52. An innocent murmur has which characteristics? Select all that apply.
1. Short induration.
2. S2 murmur.
3. Loudest in the pulmonic area.
4. Fixed and can be heard in many positions.
5. Grade III or less.
53. A child is giggling and laughing, and the nurse gently places one hand on the child’s
front and the other on the back of the chest. The sounds can be felt through the
skin. This finding is called ______________________.
54. A child returns from surgery, having had tonsils and adenoids removed. When the
parents are getting ready for discharge, the nurse gives the following instructions
about home care. Select all that apply.
1. Some secretions may be blood-tinged for a few days.
2. Run a cool-mist vaporizer in the bedroom.
3. Pain relief should be provided every 4 hours.
4. The child can resume a normal diet.
5. The child should blow the nose and cough every 4 hours.
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55. A 2-year-old is brought to the emergency department for fever and ear pain. The
parents report the child has had many ear infections and that polyethylene tubes have
been recommended, but the parents cannot afford surgery. The child is diagnosed
with bilateral otitis media. The toddler is carrying a baby bottle full of juice, and a
parent is carrying a pack of cigarettes. Which one preventive measure could be
taught to the parents to decrease the incidence of ear infections?
1. Wean the toddler from the bottle.
2. Give the toddler a decongestant before bedtime.
3. Encourage the parent to smoke outside the house.
4. Have the child’s hearing checked.
56. An 18-month-old, who attends day care, has been having a barking, hoarse-sounding
cough that comes in spasms with very noisy respirations for the last 2 nights. The
parent is concerned that the child has picked up an infection at day care. The day-care
staff indicates the child does not cough during the day, has no fever, and is eating and
drinking well. This description is most likely which condition?
1. Laryngotracheobronchitis.
2. Bacterial tracheitis.
3. Asthma.
4. Acute spasmodic laryngitis.
57. An 11-month-old was born at 28 weeks’ gestation and required 2 weeks of ventilation.
The baby is currently well and is being seen in the clinic. The physician recommends
that the baby receive preventive therapy for respiratory syncytial virus (RSV) for the
next 5 months since winter is approaching. Which medication will be ordered?
1. Respiratory syncytial virus immune globulin (RespiGam).
2. Ribavirin.
3. Palivizumab (Synagis).
4. Pneumococcal vaccine.
58. Three preschool children and their foreign-born parents come to a homeless shelter.
The family has been homeless for 3 months. The children appear somewhat unkempt
but nourished. One of the children has several enlarged cervical lymph nodes and is
running a low-grade fever. Which chronic infectious illness should be suspected in the
child?
1. Chlamydial pneumonia.
2. Tuberculosis.
3. Pertussis (whooping cough).
4. Asthma.
59. Which is assessed to diagnose pediculosis capitis? Select all that apply.
1. Crawling insects.
2. White flakes in the hair.
3. Nits attached close to scalp.
4. Inflammatory papules.
5. Dark brown hair.
60. A 7-year-old child in a classroom is disruptive with loud talking, has a short attention
span, and has difficulty organizing work. Which is the most likely diagnosis for this
child?
1. Enuresis.
2. Sexual abuse.
3. Learning disability.
4. Attention deficit-hyperactivity disorder.
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61. A child is taking haloperidol (Haldol) for schizophrenia, and the family has been
instructed to watch for extrapyramidal side effects. Which are characteristic of these
side effects?
1. Abnormal movements and twitches.
2. Inappropriate behaviors.
3. Excessive aggressiveness.
4. Thoughts of suicide.
62. A sports physical examination is being performed on a 12-year-old male. He is evaluated as a Tanner stage II. Which physical characteristics would the nurse expect?
1. Enlarging penis.
2. Height spurt.
3. Gynecomastia.
4. Deepening voice.
63. A 15-year-old girl who is an avid basketball player comes to the clinic for menstrual
irregularities. She skips meals and has lost some weight. She mentions that she has
menstrual periods every 2 weeks. Women who have menstrual periods more often
than every 21 days are ______________________.
64. Which is the nurse’s best approach to teach high school students about smoking
prevention?
1. Discuss health consequences of smoking.
2. Use scare tactics and point out the negative effects of smoking.
3. Offer alternatives to smoking such as chewing gum or doing activities that distract.
4. Have the adolescents talk with their parents about smoking.
65. A child with moderate asthma is wheezing and coughing. Which test should the
nurse perform before the health-care provider (HCP) sees the child?
1. Skin testing for allergens.
2. PCO2 levels.
3. Metered dose inhaler.
4. Peak flow.
66. Which should the nurse teach the child and parents about montelukast (Singulair)
ordered for moderate persistent asthma? Select all that apply.
1. This is an add-on medication to the child’s regular medications.
2. It can be given when the child needs it.
3. It is not to be used to treat acute episodes.
4. The parents will need to give up smoking.
5. The child will require chest physiotherapy in conjunction with the medication.
67. The nurse is caring for a child dying from leukemia. The parents want to know
how comfortable the nurse is in giving doses of pain medication that are larger than
customary. Which ethical principle of care are the parents asking about?
1. Double effect.
2. Justice
3. Honesty.
4. Beneficence.
68. The parents of a 19-year-old ask the nurse what they should do in terms of longterm care placement for their severely disabled child. Which is the nurse’s best
response?
1. “How much care do you want?”
2. “Do you have other children who could take your child into their home?”
3. “Do you have a detailed plan of care?”
4. “Are you working with an agency or social worker about this matter?”
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69. Parents of a 2-year-old with Down syndrome are told the child should be screened
for atlantoaxial instability. The nurse tells the parents that which of the following are
symptoms of this instability?
1. Mental retardation.
2. Neck pain and torticollis.
3. Vision and hearing loss.
4. Early onset of puberty.
70. Which are early signs and symptoms of hydrocephalus in infants?
1. Confusion, headache, diplopia.
2. Rapid head growth, poor feeding, confusion.
3. Papilledema, irritability, headache.
4. Full fontanels, poor feeding, rapid head growth.
71. A newborn with suspected hydrocephalus is transferred to the intensive care unit for
further evaluation and treatment. The infant’s nurse knows which of the following?
1. To use sedation as needed to keep the baby from crying or being fussy.
2. To keep the crib in a flat and neutral position.
3. To expect the infant to sleep more than an infant without hydrocephalus.
4. To not use any scalp veins for intravenous infusions.
72. Which is immediate post-operative care for shunt placement in an infant diagnosed
with hydrocephalus?
1. Wet-to-dry dressing changes at both the shunt insertion site and the abdominal
incision site.
2. Measure the child’s head at least once a day.
3. Position the infant’s head off the shunt site for the first 2 post-operative days.
4. Complete vital signs and neurological checks every 4 hours.
73. In preparing the patient and family for hospital discharge, which of the following
signs and symptoms of shunt malfunction and infection should the nurse include in
the teaching plan? Select all that apply.
1. Emesis, lethargy.
2. A change in neurological behavior.
3. Fever, irritability.
4. Diarrhea or constipation.
5. Redness along the shunt system.
74. The parents of an infant with hydrocephalus ask about future activities in which their
child can participate in school and as an adolescent. The nurse should tell the parents
which of the following is appropriate?
1. A helmet should be worn during any activity that could lead to head injury.
2. Only non-contact sports should be pursued, such as swimming or tennis.
3. Because of the risk of shunt system infection, swimming is not a sports option.
4. The child should wear a MedicAlert bracelet; then there is no need to be concerned about the shunt.
75. While assisting with a lumbar puncture procedure on an infant or small child, the
nurse should do which of the following?
1. Have the patient in a clean diaper to avoid contamination of the site.
2. Monitor the patient’s cardiorespiratory status at all times.
3. Position the patient in the prone position with the head to the left.
4. Start an intravenous line to facilitate use of conscious sedation.
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76. A 10-month-old has fallen out of the high chair and is brought to the emergency
department (ED). Place the following components of the nurse’s assessment into
order of priority.
1. Airway ______________________
2. Bleeding ______________________
3. Appetite ______________________
4. Breathing ______________________
5. Circulation ______________________
6. Level of consciousness ______________________
77. Which are associated with Guillain-Barré? Select all that apply.
1. Always fatal after 18 to 24 months.
2. Progresses cephalocaudally.
3. Complications are associated with immobility.
4. Respiratory support is a nursing priority.
5. Tube feedings or total parental nutrition may become necessary.
78. An adolescent is complaining of knees swelling and hurting, hands and feet being
cold all the time, frequent headaches, and a red rash on the cheeks and nose. Which
does the nurse suspect?
1. Multiple sclerosis.
2. Normal adolescent concerns.
3. Myasthenia gravis.
4. Systemic lupus erythematosus.
79. Which does the nurse include in discharge teaching for a 15-year-old with systemic
lupus erythematosus? Select all that apply.
1. High-protein diet.
2. Low salt intake.
3. Exposure to the sun.
4. Killed-virus vaccines.
5. Systemic corticosteroids.
6. Antimalarials.
80. A 12-year-old cut a hand while climbing a barbed-wire fence. What should the nurse
discuss with the parents regarding need for tetanus vaccine? Select all that apply.
1. No tetanus vaccine is necessary; it is too soon since the child’s scheduled Tdap
was given.
2. Tetanus is a potentially fatal disease.
3. Puncture wounds are less susceptible to tetanus.
4. There will be mild soreness at the injection site.
5. Tdap should be administered.
6. Td should be administered.
81. A parent calls the nurse for dosing information for Pepto-Bismol and aspirin for
children who are 8 and 9 years old and are ill. Which does the nurse advise? Select
all that apply.
1. 15 ml of Pepto-Bismol after every diarrhea stool.
2. 81 mg baby aspirin every 4 hours.
3. No medications are necessary.
4. Pepto-Bismol contains aspirin.
5. Diet as tolerated.
6. Reye syndrome is associated with aspirin use.
82. Which is/are the most common, nonlethal complication(s) occurring from meningitis?
1. Cranial nerve deficits.
2. Epilepsy.
3. Bleeding intracranially.
4. Cerebral palsy.
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83. Which should the nurse teach the parent of a child with suspected meningitis?
1. Antibiotics are not initiated until the cerebrospinal fluid cultures are definitive for
specificity to prevent resistance.
2. Antibiotics are useless against viral infections, so they are not used for meningitis.
3. Antibiotics should be started before the cerebrospinal fluid cultures are definitive;
culture results may take up to 3 days.
4. Antibiotic initiation is based on the age, signs, and symptoms of the child, not on
the causative agent.
84. During the nurse’s assessment, a child begins to have a generalized tonic-clonic
seizure. The drug of choice and method of administration the nurse expects the
health-care provider (HCP) to order are which of the following?
1. Lorazepam and diazepam, combined in an intravenous solution of D5W.
2. Lorazepam given intravenously or diazepam given directly into a vein.
3. Phenobarbital administered in an intravenous solution of D5W, 0.45 normal saline.
4. Phenytoin in a dextrose solution given intravenously over 1 hour.
85. Parents of a child with generalized seizures ask the nurse for information to give
their child’s teachers. Which of the following should be included?
1. A soft-padded spoon should be kept nearby to put between the child’s teeth at the
onset of a seizure.
2. Roll the child onto the abdomen, with the head to the left, so any contents can
flow from the mouth.
3. If a seizure lasts longer than 10 minutes, the parents or an ambulance should be
called.
4. As the child grows, medication dosages may need to be adjusted to control seizure
activity.
86. Which best describes the type of seizure displayed in the figure?
1.
2.
3.
4.
5.
6.
Tonic-clonic.
Absence.
Atonic.
Akinetic.
Myoclonic.
Infantile spasm.
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PEDIATRIC SUCCESS
87. Which best describes the type of seizure displayed in the figure?
1.
2.
3.
4.
5.
Infantile spasm.
Febrile seizure.
Simple partial seizure with motor signs.
Simple partial seizure with sensory signs.
Atonic partial seizure.
88. A 14-year-old sustained a grade III concussion while playing football. Which statement made by the parents indicates that further education is needed?
1. “Our child will not be able to play football until recovery is complete.”
2. “Our child needs to get back to school quickly, as there are midterms next week.”
3. “Our child’s headaches may continue for the next 6 months; we should call the
physician if the headaches get worse.”
4. “If our child suffers another concussion before recovery is complete, brain injury
will be compounded.”
89. The nurse is doing discharge teaching for a 3-month-old with a new shunt placed for
hydrocephalus. Which are signs and symptoms of hydrocephalus that the parents
may see if the shunt malfunctions? Select all that apply.
1. Vomiting.
2. Irritability.
3. Poor feeding.
4. Headache.
5. Sunken fontanel.
6. Seizures.
7. Inability to wake up infant.
8. Hyperactivity.
90. When introducing solid foods into an infant’s diet, it is important to introduce one
food at a time in order to rule out ______________________.
91. The injection site of choice for a 6-month-old receiving immunizations is the
______________________.
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CHAPTER 15 COMPREHENSIVE EXAM
92. Infants should ride in a ______________________ car seat until 2 years of age.
93. According to Piaget, the school-aged child is in the ______________________ stage
of cognitive development.
94. According to Freud, the most significant achievement of toddlers is
______________________.
95. Seizures that originate in one hemisphere are called ______________________.
96. The term ______________________ is commonly defined as stiffness of the neck.
97. Which applies to brain tumors? Select all that apply.
1. Brain tumors are the most common malignancy in the United States.
2. Although an exact cause is unknown, an association has been linked to paints and
radiation.
3. All children with brain tumors present with very similar manifestations.
4. Brain tumors in children usually occur below the cerebellum.
5. Symptoms of brain tumors always appear rapidly.
98. Which applies to cerebral palsy? Select all that apply.
1. It is the most common chronic disorder of childhood.
2. Hyperbilirubinemia increases the risk of cerebral palsy.
3. It is a progressive chronic disorder.
4. Most children do not experience any learning disabilities.
5. There is a familial tendency seen in children with cerebral palsy.
99. Which applies to encephalitis? Select all that apply.
1. Usually caused by a bacterial infection.
2. A chronic disease.
3. Most commonly seen after a varicella infection in the newborn population.
4. Newborns diagnosed with encephalitis often have extensive neurological
problems.
5. Can be seen with meningitis.
100. Which approach gives the most support to parents grieving over a terminally ill
newborn?
1. State, “You are both still young and will be able to have more children.”
2. Avoid the parents; let them ask you questions.
3. Offer rationalizations for the child’s terminal illness.
4. State, “You are still feeling all the pain of your child’s illness.”
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ANSWERS AND RATIONALES
The correct answer number and rationale for why
it is the correct answer are given in boldface blue
type. Rationales for why the other possible answer
options are incorrect also are given, but they are
not in boldface type.
1. 1. Newborns may not void spontaneously in
the first 12 hours of life, but they void
within the first 24 hours of life.
2. Most, but not all, babies lose approximately
10% of their body weight in the first 3 to
4 days of life.
3. Breastfed infants should regain their
birth weight by 14 days of life.
4. Many babies do not initially awaken spontaneously for nursing; initially, the mother
may need to offer the baby the breast every
2 to 3 hours.
TEST-TAKING HINT: Breastfed infants usually
start to gain weight once their mother’s
milk comes in about day 4 of life.
2. 7.5.
Change 3400 g to kg, and then multiply by
2.2 lb/kg. Divide 3400 g by 1000 g/kg = 3.4 kg.
Multiply 3.4 kg by 2.2 lb/kg = 7.48 lb. Round
up to 7.5 lb.
TEST-TAKING HINT: The test taker must
know the correct formulas and equivalencies to use.
3. 1. Hypotonia is of concern because a floppy,
limp infant may have suffered a birth insult
or has a genetic condition such as Down
syndrome.
2. Babies have a symmetric appearance and do
not develop hand preference (asymmetry)
until 18 to 24 months.
3. A full-term, healthy newborn initially has a
flexed posture because it has been curled up
in the uterus.
4. A full-term, healthy newborn initially
has a flexed posture because it has been
curled up in the uterus.
TEST-TAKING HINT: The nurse should expect
to see an infant who has tone and strength,
although not in its fully developed state.
4. 1. The Landau reflex occurs when the infant
is suspended prone; the infant will raise the
head and extend the trunk upward.
2. Clonus is elicited by a brisk dorsiflexion of
the foot that elicits oscillating movements
of the ankles and knees.
296
3. This reflex is called the asymetric tonic
neck. When an infant’s head turns to
one side, the arm and leg on the same
side extend, and the opposite arm and
leg flex.
4. The Moro reflex is another name for the
startle reflex.
TEST-TAKING HINT: The asymmetric tonic
neck reflex is a specific posture that is assumed by the newborn when the head is
turned or moved quickly.
5. 1. Newborn screening tests screen for a large
number of congenital diseases.
2. All states currently screen for phenylketonuria and hypothyroidism.
3. Individual states determine which diseases
are screened for, not the parents.
4. Insurance companies do not determine
which newborn screening tests are conducted.
TEST-TAKING HINT: The parents want to
know what the purpose of the test is.
6. 1, 2, 4, 5.
1. Learn as much as possible about the
child.
2. Expect to have some conflict with cultural differences and age.
3. Children who are adopted when they are
older than 2 years of age know their biological families and have feelings about their
adoption. It is best to discuss this openly
with the child.
4. Setting clear behavioral expectations for
the child will aid in the assimilation into
the family.
5. It is always good to retain some part of
the child’s original name, such as a middle name, to maintain the link with their
previous family and culture.
TEST-TAKING HINT: When children are
adopted at an older age, they have memories of their previous family, and these will
need to be incorporated into rearing the
child.
7. 2, 3, 5.
1. Young children who are experiencing a divorce have very poor self-esteem and blame
themselves for the separation.
2. They exhibit loss of appetite and poor
sleep patterns.
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3. Preschool and young school-aged children feel the parent who is leaving the
family is abandoning them. They also
develop increased anxiety.
4. Older school aged-children may become
dictatorial and aggressive and show a decline in school performance.
5. The 5-year-old can verbalize feelings
about divorce and the changes that are
going to take place within the family.
TEST-TAKING HINT: This child is a young
school-aged child and is in the Piaget
stage of ego formation.
8. 2, 3, 6.
1. Larger day cares do not necessarily have
qualified staff and age-appropriate activities for the child or infant.
2. In choosing a day care, it is important
for parents to see that the health and
safety requirements of the law are
maintained.
3. Each child gets the attention that is
required for maintaining a healthy,
happy child. Caretakers should be loving and supportive of the children and
parents.
4. Activities should be age-appropriate for
the child.
5. Child-care ratios, as well as class size,
should be small, and staff should not feel
they have more work to do than they can
manage.
6. Child-care ratios, as well as class size,
should be small, and staff should not
feel they have more work to do than
they can manage.
TEST-TAKING HINT: The infant is only
6 months old.
4. Small genitalia and long, thin arms and
legs are seen with Klinefelter syndrome;
this is seen only in males.
TEST-TAKING HINT: Turner syndrome is a
sex chromosome anomaly that is missing
one complete X chromosome. It is the
only known monosomy defect that produces a viable fetus.
11. 1. The triple marker screen, amniocentesis,
and chorionic villus sampling require either a venipuncture or uterine puncture.
2. The ultrasound is appropriate for a
noninvasive procedure. It would detect
multiple gestations and structural abnormalities, but it would not detect
biochemical abnormalities.
3. The triple marker screen, amniocentesis,
and chorionic villus sampling require either a venipuncture or uterine puncture.
4. The triple marker screen, amniocentesis,
and chorionic villus sampling require either a venipuncture or uterine puncture.
TEST-TAKING HINT: The only test that does
not require a blood sample is the ultrasound. Biochemical testing, however,
should be encouraged because it will
provide valuable information about the
pregnancy.
9. 1, C; 2, E; 3, F; 4, A; 5, D; 6, B.
TEST-TAKING HINT: First match the word
with the definition you know, then look
for matches that are less familiar.
12. 1. In a probability equation, each pregnancy is an independent event.
2. The probability of having a child with
cystic fibrosis is 1 chance in 4, whether
the first or the fourth baby.
3. The probability of having a child with
cystic fibrosis is 1 chance in 4, whether
the first or the fourth baby.
4. The probability of having a child with
cystic fibrosis is 1 chance in 4, whether
the first or the fourth baby.
TEST-TAKING HINT: Probability is a risk
assessment term and denotes that a risk is
present for the family.
10. 1. Cleft lip and palate occur in many syndromes such as trisomy 13 and VATER,
but they are not associated with Turner
syndrome.
2. A weak, high-pitched cry is seen in babies
with cri du chat.
3. A low-set posterior hairline, webbing
of the neck, and lymphedema of the
hands and feet are characteristic of
Turner syndrome.
13. 1. It is appropriate to develop a pedigree
once the provider has discussed this issue
with the patient.
2. It is appropriate to take a family history
once the provider has discussed this issue
with the patient.
3. Working as a team with the provider
and sharing this information enables
the provider to make appropriate
decisions.
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4. It is appropriate to make a referral for
genetic counseling once the provider has
discussed this issue with the patient.
TEST-TAKING HINT: The young woman is
questioning whether mental retardation
can be inherited. The provider will need
to discuss what her understanding of that
concept is.
14. 1. Some Jewish sects believe in numerous
dietary kosher laws that they must follow.
2. Muslims believe that Allah cures but
sometimes works through humans to provide treatment.
3. Catholics encourage anointing of the sick.
4. Jehovah’s Witnesses are opposed to
transfusions, and many are opposed to
albumin, globulin, and factor replacement. Generally they are not opposed
to non-blood plasma expanders.
TEST-TAKING HINT: The child’s complete
blood count is low, and the child will require blood or a blood volume expander.
15. 1, C; 2, B; 3, E; 4, D; 5, A.
TEST-TAKING HINT: Select the beliefs that
are familiar within a specific culture to
determine the country of origin; then
consider cultural values to determine the
ones you are less sure about.
16. 1. People tend to “do other things” while
talking. The family does not hear well, so
this will be inappropriate.
2. When communicating with parents
who are hearing-impaired, maintain
good eye contact and allow them to
read lips.
3. It is best to talk in short but concrete
ideas, and for teaching complex material
drawings and charts should be used.
Enunciate clearly, and talk slowly.
4. The visit requires that the family be able
to understand what is being said by the
provider. A trained hearing dog is not
part of this priority.
TEST-TAKING HINT: The parents are deaf.
Scheduling an interpreter for the hearingimpaired will benefit the family in understanding the entire message. In helping
the family benefit from the visit, also utilize the senses of sight, touch, and smell
to communicate.
17. 1. The term “legally blind” means a person
with central visual acuity of 20/200 or less
in the better eye using corrective lens.
2. This statement asks the teenager to tell if
there is enough vision to read books,
which may not be the case.
3. Having the teenager explain what can
be seen will assist in learning the
teen’s visual capabilities. Asking the
teenager to explain initiates rapport
and builds trust.
4. This statement asks the teenager to tell
you if there is enough vision to read
books, which may not be the case.
TEST-TAKING HINT: This is a teenager
with a chronic disability; therapeutic communication is always appropriate to use in
interactions.
18. 1. Although washing the child’s hands needs
to occur, this is not the first priority.
2. Many eye injuries require immediate care
with follow-up by an ophthalmologist.
3. Irrigating the eye, unless there is a chemical injury, may further irritate the eye
problem. With chemical injuries, time is
of the essence in diluting the chemical.
This injury is stated to be a foreign body.
4. Examine the eye, and check for a foreign body before attempting to treat
the injury or determining the plan of
action.
TEST-TAKING HINT: The first step in the
nursing process is to assess the problem.
19. 1. Dysfluency is speech with abnormal
rhythms, such as repetitions in sounds
or words. A stutter is described as
tense repetitions of sounds or complete blockages of sounds.
2. Children who substitute or omit consonants have articulation errors.
3. A child who speaks in a monotone has a
voice disorder. Hypernasal speech is
prominent in children with palatal weakness and cleft palate repair.
4. Hypernasal speech is prominent in children with cleft repairs of the hard and
soft palate.
TEST-TAKING HINT: The definition of fluent speech is understandable speech.
20. 1. It is important to discuss the findings that
the parents have presented and not peripheral information that may or may not
be necessary to their concern.
2. Children with autistic-like features
lack many social skills, such as seeking
reciprocity and comfort from parents
and maintaining eye contact when
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someone is speaking with them. They
have an inability to develop peer
relationships.
3. It is important to discuss the findings that
the parents have presented and not peripheral information that may or may not
be necessary to their concern.
4. It is important to discuss the findings that
the parents have presented and not peripheral information that may or may not
be necessary to their concern.
TEST-TAKING HINT: Autism is a complex
developmental disorder that presents with
behavioral and intellectual deficits. Language acquisition is an indicator of cognitive development.
21. 1. Post-concussion syndrome is a common finding in children who have suffered a head injury. Symptoms in the
infant include pallor, sweating, irritability, and sleepiness. The symptoms
begin within minutes to hours.
2. Plethora and hyperthermia may indicate a
number of problems, such as being overdressed, crying, and stress.
3. Crying with fear in an 8-month-old is an
expected behavior at this time.
4. Babies have a positive Babinski reflex
until they are walking, which means they
have toe fanning; after that, it should be a
negative finding.
TEST-TAKING HINT: Post-concussion syndrome is common in children younger
than 1 year who have suffered a head
injury.
22. 1. Babies who have failure to thrive can tolerate a cows’ milk formula, but they need
to have a diet modifier to increase calories, such as polycose powder or mediumchain triglycerides oil.
2. The parent is describing symptoms of
a cows’ milk allergy and mentions
there are many family members with
allergies.
3. Phenylketonuria is an inborn error of
metabolism presenting with growth failure, failure to thrive, and frequent vomiting. The infants are placed on a low
phenylalanine formula, such as Lofenalac.
4. Portagen formula is used to nourish babies with pancreatic insufficiency or intestinal resections. Frequently these children
are diagnosed with cystic fibrosis and
present with failure to thrive, steatorrhea,
bulky stools, and abdominal pain.
TEST-TAKING HINT: Consider the symptoms and the history of allergies in other
family members.
23. 1. This is an important vital sign to assess,
but it is not specific to cutis marmorata.
2. This is an important vital sign to assess,
but it is not specific to cutis marmorata.
3. This is an important vital sign to assess,
but it is not specific to cutis marmorata.
4. Cutis marmorata is transient mottling
of the body when the infant is exposed
to cold. It is important to check the
baby’s temperature. Cutis marmorata
is a change in the color of the skin.
TEST-TAKING HINT: This question involves
a newborn with a somewhat common
problem.
24. 1. Placing the infant supine will compromise
the function of the unaffected lung.
2. To optimize the baby’s breathing, position the infant with the affected side
down. In this way, the unaffected lung
can expand fully. Infants are primarily
thoracic breathers, so it is important
to maximize use of the unaffected lung.
The infant also has an Erb/brachial
palsy, which further limits the function
on the affected side.
3. Placing the infant on the unaffected side
will decrease the ability to expand the unaffected lung maximally and increase the
work of breathing.
4. Placing the infant prone compromises the
function of the unaffected lung.
TEST-TAKING HINT: A phrenic nerve paralysis results in diaphragmatic paralysis and
paradoxical chest movements.
25. 1. The baby would not have a hepatitis B
titer unless the mother was hepatitis
B–positive.
2. This baby has an ABO blood incompatibility, with the mother being O+
and the baby being A+. The total
bilirubin is a value that combines the
unconjugated and the conjugated
bilirubin levels. The newborn would
have an increase in the unconjugated
bilirubin (lipid-soluble) as a result of
the presence of antibodies to the
mother’s blood type.
3. The complete blood count does not necessarily explain the jaundice.
4. The sedimentation rate indicates inflammation somewhere in the body.
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TEST-TAKING HINT: The baby is 2 days old;
the mother’s blood is O+; and the baby’s
blood is A+. Mothers with O+ blood type
have the antibodies to types A and B, regardless of whether they have had other
children.
26. 1. The baby is already becoming increasingly jaundiced and, if the bilirubin level
is not controlled, there is the risk of
kernicterus.
2. Lethargy is symptomatic of a number of
risks that a newborn might encounter, such
as sepsis, dehydration, and hypothermia.
3. The signs of a blood exchange transfusion reaction are focused on an unstable
temperature. If the newborn becomes
too cool, the infant could develop respiratory distress or bradycardia. If the
baby’s temperature becomes too high,
there would be a dramatic change in
blood pressure, with either hypertension or hypotension causing vascular
collapse. If the baby becomes hyperthermic, the donor red blood cells could
also be damaged, further increasing the
jaundice.
4. Irritability would be symptomatic of a
number of risks that a newborn might
encounter, such as sepsis, dehydration, or
hypothermia.
TEST-TAKING HINT: The question is asking
for signs of a transfusion reaction in a
newborn.
4. Non-nutritive sucking appears very
effective in decreasing neonatal pain.
5. The baby will feel the pain whether
asleep or awake.
TEST-TAKING HINT: The question is asking
for nursing measures that will help decrease the pain with a heel stick.
29. 1. The Pain Assessment Tool would not
likely be used on an inpatient unit other
than a neonatal intensive care unit.
2. The Neonatal Infant Pain Scale would
not likely be used on an inpatient unit
other than a neonatal intensive care unit.
3. The Premature Infant Pain Profile would
not likely be used on an inpatient unit
other than a neonatal intensive care unit.
4. The acronym POPS stands for PostOperative Pain Score.
30. 1, 2, 3, 5.
1. A polysomnogram can record the
heart rate and respirations.
2. A polysomnogram can record the brain
waves.
3. A polysomnogram can record the eye
movements and body movements.
4. Unless the child is being videotaped while
asleep, the polysomnogram is not able to
pick up cyanosis or plethora.
5. A polysomnogram can record the endtidal carbon dioxide.
TEST-TAKING HINT: A polysomnogram is a
complex diagnostic tool that records electrical and muscle movements.
27. 250 mg.
Convert the weight of 22 lb to kilograms.
There are 2.2 lb per kilogram of body
weight, so divide 22 lb by 2.2. The baby
weighs 10 kg. By multiplying 10 kg by
25 mg/kg recommendation per day, the
total intake of phenylalanine per day for
this infant is 250 mg.
TEST-TAKING HINT: The test taker must
know the correct formulas and equivalencies to use.
31. Cognitive.
Piaget’s late phase of sensorimotor development occurs between 12 and 24 months and
is a time when cognitive development occurs
rapidly. Reasoning skills are still very primitive. The main cognitive skill of early childhood is language acquisition.
TEST-TAKING HINT: Language acquisition is
the main cognitive achievement of early
childhood.
28. 1, 3, 4.
1. Wrapping the foot in a warm washcloth increases the vasodilation and
makes obtaining the sample easier.
2. Using EMLA cream on the heel before
the stick has not been shown to decrease
the pain response of the infant.
3. Swaddling appears very effective in
decreasing neonatal pain.
32. 1. Pre-operational thought starts around
2 years of age and continues until late in
the third year.
2. Toddlers are self-centered but are curious
and want to learn. They love to explore
their environment and try new things.
3. Toddlers think in very broad terms; it
is difficult for them to see that changing the bed will not change the entire
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process of sleeping. Global organization is when change in one part
changes the whole thing.
4. The toddler is globally afraid of changes
but is not phobic about the bed.
TEST-TAKING HINT: Pre-operational
thought implies that the child does not
think in logical patterns. Global organization is changing one part and affecting the
entire thing.
33. 1, 2, 3, 5.
1. Many children who have difficulty with
temper tantrums are described by the
family as “bad” or “difficult” in all aspects of their life. This description often carries over into all the activities
and conversations that the family has
with the child and degrades the positive aspects of the child’s personality.
2. Tantrums are frequently associated
with only one aspect of a child’s life,
and this should be identified quickly so
that changes can be instituted in the
approach to the problem.
3. Tantrums that result in harm to the
child or to others should be dealt with
quickly; professional help may be
needed.
4. The Internet is a frequent source of conflicting information, but families frequently
seek help from it. Not all the information
on the Internet is appropriate or correct.
5. Discipline and inappropriate behavior
management techniques may worsen
the temper tantrums.
TEST-TAKING HINT: Consider the child’s
age and what are appropriate and inappropriate behaviors for this age.
34. 1. It would be more appropriate for the parents to tell the child what “might” happen
at the visit rather than say the visit will
not hurt. Often, children perceive simple
activities such as looking in the mouth or
touching the skin as invasive and hurtful.
2. Telling the child that there are consequences for having fear of something new
is inappropriate.
3. Modeling appropriate behavior for the
child by having the child go with a
parent creates a positive preparation
for attending the dentist.
4. Bribing a child to “be good” sets up a
negative approach to teaching a child.
The child will then want a treat for every
visit to the dentist.
TEST-TAKING HINT: The parents may be
projecting their fear of the dentist onto
the child.
35. 1, 2, 5.
1. Hiding the bottle and offering a cup is
a good way to start to wean a toddler.
2. Putting only drinking water in the bottle is a good way to start to wean a
toddler.
3. Nighttime bottles should be discontinued
as soon as the child is able to drink fluids
from the cup. Nighttime bottles allow the
milk or formula to coat the teeth all night
long, encouraging tooth decay.
4. Starting to use a pacifier with a toddler
who should be weaned from the bottle by
11 to 12 months of age is inappropriate.
5. Nighttime bottles should be discontinued as soon as the child is able to
drink fluids from the cup. Nighttime
bottles allow the milk or formula to
coat the teeth all night long, encouraging tooth decay.
TEST-TAKING HINT: Weaning should occur
before the first birthday unless medically
indicated. The bottle should be less appealing and less available to the child once
the child is able to drink from a cup.
36. 1. The parents have indicated that neither
one has the motivation or time to do the
toilet training.
2. The child is 2 years old and may not
be physically, emotionally, or psychologically ready to toilet train.
3. A toddler will say “no” to most questions;
that does not make the child stubborn.
4. Having the child sit on the toilet for more
than 2 or 3 minutes is inappropriate.
TEST-TAKING HINT: Most children initiate
toilet-training at 18 to 24 months on
their own.
37. 2, 3, 4.
1. The safest place for a child to ride in a car
is in the middle of the back seat.
2. Legally, a child must weigh 60 lb and
be 8 years old to ride in a seat belt
without a booster.
3. The seat belt, whether in a booster or
on a seat, should be worn low on the
hips and not across the abdomen.
4. The shoulder strap, for safety purposes, should be across the chest and
not across the face or neck.
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5. Tether straps help to secure the seat belt
in position when using a car seat or
booster seat and should not be optional.
TEST-TAKING HINT: The child’s age and
weight determine the seat belt/booster
seat requirements.
38. 1. Fifth disease is caused by the parvovirus,
and the rash is initially described as
“slapped cheek,” with this impression
lasting 3 to 4 days.
2. Roseola is caused by herpesvirus type 6
and is usually seen in children from
6 months to 3 years of age.
3. Scarlet fever is a bacterial disease and has
a rash that feels like sandpaper.
4. The most likely diagnosis for this child
is chickenpox, which is caused by the
varicella zoster virus. This is seen in
young children and is highly contagious to others in the classroom and at
home. It initially presents with a high
fever for 3 to 4 days.
TEST-TAKING HINT: The pruritic nature of
the rash and the distribution primarily on
the trunk in clusters and patches give
clues as to its cause.
39. 2, 4.
1. Young children absorb most of the lead
that enters their body.
2. Homes built between 1900 and 1950
most likely contain lead-based paints.
3. The acceptable blood level is 5.0 mcg/dL
or less.
4. Lead can affect any part of the body,
but the brain, nervous system, kidneys,
and blood are likely to be most
affected.
5. In Hispanic and Arabic cultures, some
painted jars in which candy is stored are
painted with lead paints. Some medicinals, such as azarcon, greta, paylooh,
surma, and lozeena, are sources of lead.
TEST-TAKING HINT: Low-income families
are frequently at risk for lead exposure
because of living in older homes often in
disrepair. Often, families who have emigrated from other countries are unaware
of risks such as lead toxicity in the community.
40. 95th/90th.
The blood pressure table for boys 1 to
17 years is based on height for age. The vertical column represents the percentiles for a
specific age. The horizontal columns represent the percentiles of blood pressure for a
specific height. Locating the blood pressure
percentile shows the systolic pressure to be in
the 95th percentile and the diastolic pressure
to be in the 90th percentile.
TEST-TAKING HINT: Find the 50th percentile vertical line for systolic pressure,
and follow it to age 9. Find the 50th percentile on the vertical line for diastolic
pressure, and follow it to age 9.
41. 1. The American Academy of Pediatrics
recommends a daily intake of 0.4 mg
of folic acid daily for all women of
childbearing age.
2. Although eating fruits and vegetables is
part of a healthy lifestyle, the young
woman will not gain any additional folic
acid in her diet through those foods.
3. Although eating breakfast is part of a
healthy lifestyle, the young woman
will not gain any additional folic acid in
her diet.
4. The addition of folic acid at 0.4 mg daily
to the diet will decrease the risk of having
a baby with a neural tube defect by 50%
to 70%.
TEST-TAKING HINT: The teen is looking for
a suggestion for preventing neural tube
defects.
42. 30.
Change the height to inches. Locate the
height of 65 inches on the vertical axis. Locate the weight of 180 lb on the horizontal
axis on the same line as the height. Look up
at the body mass index line at the top, and
it indicates the BMI is 30. This classifies as
obese.
TEST-TAKING HINT: Weight for a person’s
height is the determinate of a BMI.
43. Appendix.
The appendix is used to create the stoma between the bladder and the abdominal wall.
The abdominal stoma allows the young
woman to perform the clean intermittent
catheterization comfortably with less dexterity required.
TEST-TAKING HINT: The family is looking
for an alternate way to do clean intermittent catheterizations. The appendix is not
a necessary piece of bowel, so it can be
utilized easily for this procedure.
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44. 1. Giving antihistamines and steroids before
and after procedures will help to decrease
the response to the exposure.
2. The most important intervention for
any person with latex allergy or sensitivity is to prevent contact with latex
products.
3. Once the radioallergosorbent test confirms that a person is allergic to latex, the
test does not need to be repeated.
4. Using latex-free gloves is one way to
decrease exposure to latex.
TEST-TAKING HINT: This is a known allergen in a child at risk for latex sensitivity
or allergy.
45. 1. Arnold-Chiari malformation is a herniation of the brainstem into the cervical spinal canal through the foramen
magnum.
2. Anencephaly is absence of the brain.
3. Tethering of the spinal cord occurs when
the tissue surrounding the cord adheres to
the underlying bony or tissue structure of
the spinal canal.
4. Perinatal hemorrhage is one cause of hydrocephalus but is not a brain malformation.
TEST-TAKING HINT: Type 2 Arnold-Chiari
malformation is frequently seen in infants
and children with myelomeningocele.
46. 1. Diaper dermatitis should be assessed with
the diaper change, but it is not specific to
the risks of wearing a Pavlik harness.
2. Talipes equinovarus is congenital clubfeet
and does not occur as a result of the
harness.
3. An infant wearing a Pavlik harness is
at risk of leg shortening on the affected side and limited abduction. The
straps on the harness may need adjustment and lengthening frequently.
4. Pain of any kind warrants further
assessment.
TEST-TAKING HINT: The child has hip dysplasia and is wearing a corrective (therapeutic) device, the Pavlik harness. It is
important to check for problems or complications that are caused by the harness.
47. 1. Infants with clefts of the palate are at
greater risk for ear infections once they
are eating and sucking on a breast or
bottle.
2. It is important to help the mother bond
with the baby, but nursing or sucking on
the bottle helps to create positive feelings
between the baby and the mother.
3. The cleft palate is not repaired until the
baby is closer to 9 to 15 months of age
when speech begins.
4. The primary goal of any newborn with
a cleft palate is to establish feeding
and sucking.
TEST-TAKING HINT: Getting started with
feeding and nursing is difficult for the
newborn with a cleft palate.
48. Gastroschisis.
Gastroschisis is a herniation of the abdominal
wall without a peritoneal sac and intestines
outside the abdominal cavity.
TEST-TAKING HINT: The stem of the word,
gastroc-, is “stomach,” and -schisis is “a
split.” This is different from an omphalocele, which has the peritoneal sac present
and intact.
49. 1. The National Advisory Committee on
Immunizations is a subgroup of the U.S.
Public Health Service. The American
Medical Association makes recommendations on adult care.
2. The two organizations in the United
States that govern the recommendations on immunization practices are
the Advisory Committee on Immunization Practices (ACIP) of the
U.S. Public Health Service and the
Committee on Infectious Diseases of
the American Academy of Pediatrics.
3. The National Immunization Program is a
part of the U. S. Public Health Service.
Pediatric Infectious Disease Committee
makes recommendations on treatment of
known infectious diseases in children.
4. Canada has its own advisory committee
called the National Advisory Committee
on Immunization under the Minister of the
National Health and Welfare Department.
TEST-TAKING HINT: The United States
Public Health Service is the umbrella organization for all national health issues.
The American Academy of Pediatrics has
been instrumental in combating infectious
diseases in the United States and publishes the Red Book on recommendations
for preventing and managing infectious
diseases in children.
50. 1. EMLA cream does not decrease local
reactions.
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2. EMLA cream does not decrease local reactions, and changing the needle has not
been shown to decrease local reactions.
3. The vastus lateralis and the ventrogluteal muscles are recommended
sites for a child of any age.
4. Using distraction will minimize pain but
not minimize local reactions.
TEST-TAKING HINT: The question is asking
for a procedure that the nurse can perform to minimize local reactions.
51. 1. Mitral regurgitation is best heard between
S2 and the beginning of S1. It is accentuated by exercise.
2. The S2 sound is caused by the closure
of the pulmonic and aortic valves. A
fixed splitting of the S2 sound is indicative of an atrial septal defect.
3. A functional murmur does not denote a
cardiac defect but may indicate anemia or
some other physiological abnormality.
4. The pericardial friction rub is a highpitched grating sound that is indicative of
pericarditis.
TEST-TAKING HINT: The S1 sounds are
caused by closure of the tricuspid and
mitral valves. The question involves an
S2 sound and is indicative of closure of
the semilunar valves.
52. 1, 3, 5.
1. An innocent murmur does not have an
anatomical or physiological abnormality; it is a sound of short duration,
grade III or less, and is best heard in
the pulmonic area of the chest (second
intercostal space close to the sternum).
2. An S2 murmur is considered pathological
until proved otherwise.
3. An innocent murmur does not have an
anatomical or physiological abnormality;
it is a sound of short duration, grade III
or less, and is best heard in the left pulmonic area of the chest (second intercostal space close to the sternum).
4. Murmurs that are innocent or functional
vary in their intensity and the position in
which they can be heard. Pathological
murmurs are fixed and radiate throughout
the chest.
5. An innocent murmur does not have an
anatomical or physiological abnormality; it is a sound of short duration,
grade III or less, and heard best in the
pulmonic area of the chest (second intercostal space close to the sternum).
TEST-TAKING HINT: This is an otherwise
healthy child. The Erb point (second and
third intercostal space, midclavicular area
on the left) is a frequent site to locate innocent murmurs.
53. Vocal fremitus.
The conduction of voice sounds through the
chest and respiratory tract is called vocal
fremitus. The decrease in fremitus indicates
obstruction in the airways, as would occur
with asthma or pneumothorax. The increase
in fremitus occurs with pneumonia.
TEST-TAKING HINT: Fremitus is the conduction of voice sounds through the respiratory tract.
54. 1, 2, 3.
1. The nurse should alert the parents to
the fact that the child may have some
blood-tinged secretions for a few days
afterward.
2. Using a cool mist vaporizer helps to
decrease the viscosity of the secretions.
3. Pain relief every 4 hours is indicated.
4. The child should not be eating foods that
are rough or fibrous but rather stay on a
soft or liquid diet for a few days to allow
healing.
5. Blowing the nose and coughing are contraindicated because this may loosen the
clot that has formed over the surgical site.
TEST-TAKING HINT: The care and comfort
measures are those that enable the parents to relieve pain and have decreased
stress and worry about the surgery.
55. 1. Weaning the toddler off the bottle is
the best tactic.
2. Giving the toddler a decongestant before
bedtime is not recommended because the
primary problem is obstruction of the eustachian tube due to intrinsic or extrinsic
causes. Decongestants thicken and make
passage of fluid out of the middle ear
more difficult.
3. Smoking outside the house is frequently
recommended as a way to prevent exposure of second-hand smoke to children,
but the smoke still clings to the parents’
clothing and hands and continues to be a
source of exposure. Smokers should
change their shirts and wash hands before
handling the child.
4. Following treatment for otitis media, it
is important to have the child’s hearing
checked because drainage from the
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middle ear may persist beyond the days of
treatment. It will not prevent recurrence
of the otitis media.
TEST-TAKING HINT: The question is asking
for a major preventive measure for otitis
media.
56. 1. Laryngotracheobronchitis is seen in infants and young school-aged children and
is viral in origin with accompanying
symptoms of brassy cough, low-grade
fever, hoarseness, but otherwise well
appearance.
2. Bacterial tracheitis is caused by staphylococcus with a croupy cough, purulent
secretions, high fever, and a need for
antibiotics.
3. Asthma is a chronic inflammatory disease
of the airways. In susceptible children, inflammation causes cough, wheezing, and
chest tightness.
4. This is the history of a child with
acute spasmodic laryngitis. Symptoms
of inflammation are absent or mild.
Some children are thought to be predisposed to this, with allergy or psychogenic factors as an underlying
cause.
TEST-TAKING HINT: The child is well during the day and asymptomatic for fever or
loss of appetite.
57. 1. RespiGam is also a prophylactic for respiratory syncytial virus, but it is primarily
an immunoglobulin G that provides neutralizing antibodies against subtypes A
and B of the virus. It must be given intravenously monthly, which is more difficult
in terms of administration.
2. Ribavirin is an antiviral agent and is given
in a hospital for treatment of respiratory
syncytial virus.
3. The American Academy of Pediatrics
recommends that infants born before
32 weeks’ gestation and younger than
2 years who have chronic lung disease
should receive palivizumab (Synagis)
monthly as a prophylactic to prevent
respiratory syncytial virus during the
winter months.
4. The pneumococcal vaccine could be given
during these 5 months but would not protect the infant from respiratory syncytial
virus.
TEST-TAKING HINT: The infant is premature, and the winter season is starting.
58. 1. Chlamydial pneumonia is a sexually transmitted disease that would not be expected
unless sexual abuse had occurred.
2. The chronic infectious illness for
which this child is at risk is tuberculosis. The disease may present as
asymptomatic or include fever, enlarged lymph nodes, anorexia, weight
loss, night sweats, and, occasionally,
hemoptysis. It is recommended that
Mantoux skin tests be performed annually for at-risk populations such as
the homeless, first-generation immigrants, and residents of correctional
facilities.
3. Pertussis is an acute respiratory tract infection that lasts approximately 4 to 6 weeks.
4. Asthma is not contagious.
TEST-TAKING HINT: Tuberculosis is on the
rise in homeless and immigrant populations, and the child is in both categories.
59. 1, 3, 4.
1. The lice can be seen crawling about
on the scalp.
2. The nits can be described as “looking like
dandruff,” but it could also be dandruff or
seborrhea that is seen.
3. Nits can be seen, especially behind the
ears, at the nape of the neck, and close
to the hair shaft.
4. Often there are scratch marks and inflammatory papules as a result of the
itching and scratching of the scalp.
5. Head lice can be found in short and long
hair and even in coarse curly hair.
TEST-TAKING HINT: Pediculosis capitis is
common in classrooms. Because of the
frequency, many schools require the nurse
to see the louse walking on the scalp before exclusion from the classroom is permitted. Nits can be confused with dandruff, hair spray, and lint.
60. 1. Enuresis is bed-wetting, which can have
an array of causes.
2. It is important to rule out sexual abuse
before deciding on the attention deficithyperactivity disorder diagnosis. It is also
important to have a health-care provider
(HCP) do a complete physical examination and have both the teacher and the
family complete behavioral checklists before making that diagnosis.
3. It is important to rule out a learning disability before deciding on the attention
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deficit-hyperactivity disorder diagnosis. It
is also important to have a health-care
provider (HCP) do a complete physical
examination and have both the teacher
and the family complete behavioral
checklists before making that diagnosis.
4. The most likely diagnosis is attention
deficit-hyperactivity disorder because
the child has the classic symptoms.
TEST-TAKING HINT: Classic symptoms of
attention deficit-hyperactivity disorder
are impulsiveness (talking loud), inattentiveness (difficulty organizing work),
hyperactive-impulsive behavior (moodiness and being unable to finish assigned
class work).
61. 1. Extrapyramidal symptoms are motor
neuron responses that go from the
brain to the spinal cord and present as
tics, jerkiness, incoordination, and loss
of involuntary muscle control.
2. The medication is given to control the inappropriate behaviors, such as aggressiveness. If the symptoms started with the
medication, it would be important to report this to the provider.
3. The medication is given to control inappropriate behaviors, such as aggressiveness. If the symptoms started with the
medication, it would be important to report this to the provider.
4. Thoughts of suicide would warrant further evaluation of the appropriate medication for treatment.
TEST-TAKING HINT: Pyramidal tracts control voluntary muscle movements, such as
balance and walking. Extrapyramidal
tracts are those that control involuntary
motor movements, such as tics, twitches,
and spasms.
62. 1. A Tanner stage II male (early puberty)
shows signs of an enlarging penis and
loosening of scrotal skin. Puberty occurs from 91/2 to 14 years for typical
growing boys.
2. Height spurts occur toward the end of
mid-puberty.
3. Mid-puberty shows signs of breast enlargement (gynecomastia) due to elevated
estrogen levels. This is temporary.
4. A deepening of the voice occurs with
changes in the larynx toward the end of
puberty.
TEST-TAKING HINT: This is a Tanner stage
II male.
63. Anovulatory.
Young women who have periods more frequently than every 21 days, after ruling out
sexually transmitted diseases, are anovulatory.
These young women have adequate estrogen
levels but inadequate progesterone levels.
Unopposed estrogen can place a young
woman at risk for endometrial carcinoma.
TEST-TAKING HINT: The young woman is
an athlete and has also lost weight.
64. 1. Using examples of short-term consequences, such as stained teeth, unpleasant
odor, and stains on fingers, will emphasize
the teens’ most immediate needs of being
accepted by their peers. These unpleasant
effects may appear attractive.
2. Teens feel they are “invincible” and safe
from harm.
3. It is always best to focus on prevention
of smoking, and take a positive approach to how a teen might resist
smoking. Peer support groups work
well in redefining the teens’ peer
groups and give them tactics to use
against smoking.
4. Talking with parents is not always an
option for a teen.
TEST-TAKING HINT: Teens are interested
in becoming adults and are increasingly
concerned about how their peer group
sees them.
65. 1. Skin testing is done by an allergist to help
determine triggers for the asthma.
2. Taking PCO2 levels would be helpful but
would require the provider to order a
blood gas.
3. A metered dose inhaler is the device that
is used to administer the medications.
4. The Expert Panel recommends that
peak flow monitoring be used in children with asthma to determine the
severity of an exacerbation and to
guide therapeutic decision making.
TEST-TAKING HINT: The child has moderate asthma. The peak flowmeter is recommended for all children with moderate to
severe asthma as a simple tool for offices
and for patient home use.
66. 1, 3.
1. Leukotriene modifiers such as montelukast are given orally and are indicated for add-on to low-dose inhaled
corticosteroids in moderate persistent
asthma.
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2. The leukotriene modifiers should be
given on a daily basis for effectiveness.
3. The leukotriene modifiers are not to
be used for acute asthma attacks.
4. Although the parents should give up smoking for the sake of their child’s asthma, it is
not affected by the medication.
5. Chest physiotherapy is used for children
who have cystic fibrosis. It can help with
respiratory distress by loosening mucus in
the lungs.
TEST-TAKING HINT: The child has moderate persistent asthma and is currently taking low-dose medications.
67. 1. The ethical principle of double effect
states that an action has good intentions and that a bad intention is permissible if the action itself is good or
neutral, the good effect must not be
produced by the bad effect, and there
is a compelling reason to allow the bad
effect to occur if the good effect is the
primary reason for the action. The
child may require doses of pain relievers higher than is considered safe in
order to relieve the pain. If the child
dies during this treatment, the overwhelming reason for the excess medication was to make the child comfortable and decrease the intense pain.
2. Justice is the promotion of equity or fairness in every situation a nurse encounters.
For example, fair allocation of resources,
including appropriate staffing or mix of
staff to all clients.
3. There is no principle of honesty. There is
only acknowledgment of cultural differences in the dying process, honesty in
dealing with the child and the family, and
use of pain medication to relieve pain as
indicated by the circumstances.
4. Beneficence is doing or active promotion
of good, balancing the benefits and risks
of harm, taking positive action to help
others, a desire to do good.
TEST-TAKING HINT: The child is terminally
ill and in great pain and the nurse needs
to treat the child’s pain.
68. 1. The parents obviously want their son
cared for in the best and safest manner
possible.
2. The parents may not have other relatives
who are capable or willing to take care of
the child.
3. It is always best to ask the parents what
plan of care has already been instituted.
4. Many social service agencies have counselors who can assist parents with developing a specific plan and asking the right
questions. Before offering this service it is
important to ask if they already have a
plan of care.
TEST-TAKING HINT: The parents are asking
the nurse about a very personal decision.
This is a very emotional issue and should
be dealt with accordingly.
69. 1. All children with Down syndrome have
mental retardation.
2. Atlantoaxial instability is ligamentous
laxity of the atlantoaxial joint. The
symptoms of neck pain, torticollis, and
loss of bowel and bladder control indicate that instability is already present.
The purpose of the x-rays is to prevent symptoms by limiting activities if
instability is present.
3. Children with Down syndrome may have
vision and hearing loss and should be
screened before 2 years of age for both.
4. Children with Down syndrome attain
puberty at the same age as nondisabled
children.
TEST-TAKING HINT: Children with Down
syndrome have hypotonia, and the more
active they become, the more they are at
risk for displacement of the atlantoaxial
joint.
70. 1. These are signs of increased intracranial
pressure in an older child.
2. Confusion is not easily assessed in an
infant.
3. These are signs of increased intracranial
pressure in an older child.
4. Previously undiagnosed, one of the
first signs of hydrocephalus is a
bulging fontanel, followed by irritability, poor feeding, and overall rapid
head growth.
TEST-TAKING HINT: The test taker should
recognize that examination of fontanel
and head circumference is a mainstay of
the infant examination.
71. 1. No products that interfere with levels of
consciousness are used so as not to confuse assessment.
2. The head of the crib is slightly elevated to
help decrease intracranial pressure.
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3. Infants with hydrocephalus are often irritable and do not sleep well.
4. These may interfere with surgery and
shunt placement.
TEST-TAKING HINT: Answer 4 should be
known by a nurse about any patient who
is having surgery on the head.
72. 1. Dressings should be dry and free of
drainage.
2. Once a shunt is determined to be functioning properly, head measurements are
done at office visits.
3. Position the head on the side opposite
the surgical site to prevent pressure on
the shunt and valve. This provides better visibility to watch for signs of
bleeding or infection.
4. Vital signs and neurological checks will be
performed much more frequently, usually
every 1 to 2 hours initially.
TEST-TAKING HINT: Knowing post-operative
care, the test taker can eliminate answers 1
and 4.
73. 1, 2, 3, 5.
1. Emesis and lethargy can be signs of increased intracranial pressure and may
indicate an infectious process.
2. A change in behavior can be a sign of
increased intracranial pressure and can
be a sign of shunt malfunction.
3. Fever and irritability can be an indication of a possible shunt infection.
4. Although diarrhea may be a sign of illness, it is usually not a shunt complication, nor is constipation.
5. Redness along the shunt system can be
an indication of a possible infectious
process.
TEST-TAKING HINT: The test taker should
be able to identify signs of increased
intracranial pressure and signs of
infection.
74. 1. The risk of shunt breakage or obstruction is extremely low.
2. There is no reason why athletics need be
restricted. Recent studies have shown little evidence of shunt injury or malfunction with sport participation.
3. The shunt is a sterile, closed system,
without any external opening so there is
no risk of infection from swimming.
4. Even with the alert bracelet, close contacts should be aware to provide care if
necessary.
TEST-TAKING HINT: The test taker may assume a child with a shunt may be at
higher risk of injury.
75. 1. Diapers are kept rolled down and out of
the way during a lumbar puncture.
2. Airway, breathing, and circulation are
always the priority during procedures.
3. Positioning the patient should facilitate
the opening of the vertebral spaces, either
by a lateral or sitting-type position.
4. Conscious sedation is not utilized during
a lumbar puncture.
TEST-TAKING HINT: Cardiorespiratory status is always the priority in any procedure.
76. 1, 4, 5, 6, 2, 3.
1. Always first priority to assess.
4. Second aspect of ABC priority.
5. Third aspect of ABC priority.
6. Important after stabilization of the
“ABC.”
2. Important but not first priority.
3. Least important.
TEST-TAKING HINT: The test taker should
always assess ABCs first.
77. 3, 4, 5.
1. Progressive but full recovery is possible,
taking months to years.
2. Neuromuscular progression is from feet
to head.
3. Due to the progressive paralysis, immobility is a major concern.
4. The respiratory tract muscles may
become compromised with the
progression.
5. Adequate calorie intake is essential to
prevent catabolism.
TEST-TAKING HINT: The test taker should
be able to eliminate answer 1 because in
nursing there are few absolutes. Just
knowing that some sort of immobility is
involved should lead the test taker to
answers 3, 4, and 5.
78. 1. Multiple sclerosis appears initially as a
neurological disorder.
2. The offered signs and symptoms are not
normal in any age group.
3. Myasthenia gravis is a neuromuscular
disorder.
4. Butterfly rash, arthritic symptoms,
Raynaud phenomenon (cold hands and
feet), and headaches, when all are seen
together, are indicative of systemic
lupus erythematosus.
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TEST-TAKING HINT: The test taker should
know symptoms of all the involved diseases to determine which one it is.
79. 2, 4, 5, 6.
1. Low protein to keep BUN within normal
range.
2. Low salt to help control blood pressure.
3. Worsens butterfly rash.
4. More susceptible to infections and a
lowered immune response.
5. First-line therapy.
6. Indicated treatment.
TEST-TAKING HINT: Butterfly rash should be
recognized as a sign of lupus erythematosus
and that it will worsen with sun exposure.
80. 2, 5.
1. Required tetanus boosters are given at
5 years of age. If a “dirty” wound occurs
before 10 years after the last dose, a
booster is necessary.
2. Tetanus is a potentially fatal disease.
3. Puncture wounds are more susceptible to
tetanus, especially in rural areas.
4. This is a possible side effect of tetanus
vaccine.
5. Due to the increase in incidence of
pertussis in adolescents and adults,
this is the vaccine of choice.
6. Td is no longer the vaccine of choice;
DTaP is the vaccine used to help control
the growing incidence of pertussis.
TEST-TAKING HINT: Pertussis outbreaks are
occurring as immunity wanes, so there is
a need to use diphtheria, pertussis, and
tetanus for boosters.
81. 3, 4, 5, 6.
1. Pepto-Bismol contains bismuth subsalicylate, an aspirin component, and is contraindicated in children.
2. Aspirin is contraindicated in children with
viral symptoms due to the association
with Reye syndrome.
3. Allow the body to rid itself of harmful
agents. This is first-line advice.
4. Pepto-Bismol contains bismuth subsalicylate, an aspirin component.
5. This is first-line advice if there is no
vomiting.
6. Reye syndrome is associated with aspirin use and viral illness in children.
TEST-TAKING HINT: Many people are unaware of the aspirin in Pepto-Bismol and
the link to Reye syndrome.
82. 1. If infection extends into the area of
the cranial nerves, increased pressure
may cause sensory deficits.
2. Although this is a possible complication,
it is not the most common.
3. Although there is often purpura and petechiae with meningitis, there is no intracranial bleeding.
4. This condition is usually an injury incurred during the neonatal period.
TEST-TAKING HINT: The test taker should
know about complications in children
with bacterial meningitis. With meningitis
there is an increase in intracranial pressure, which can put pressure on the cranial nerves.
83. 1. A delay in administering antibiotics can
be fatal.
2. Cerebrospinal fluid cultures may require
up to 3 days to determine the causative
agent.
3. Immediate antibiotic therapy is necessary to prevent death and avoid
disabilities.
4. Antibiotic choice is based on the most
likely causative agent for that particular
age group. If the culture indicates a resistant organism, the antibiotic can be
changed.
TEST-TAKING HINT: The test taker may be
tempted to choose answer 2 if the urgency
of early treatment is not understood.
84. 1. Although these are the correct drugs, they
are not administered simultaneously.
2. These continue to be the drugs of
choice for in-hospital management of
tonic-clonic activity. These are the
recommended methods of administration; diazepam compromises intravenous tubing.
3. Phenobarbital is not the drug of choice
for in-hospital management of tonicclonic activity.
4. Intravenous phenytoin is given by slow
intravenous push. Dextrose causes phenytoin to precipitate.
TEST-TAKING HINT: The test taker needs to
know emergency care of a child having
tonic-clonic seizures.
85. 1. Trying to insert something into a seizing
person’s mouth can lead to injury.
2. Anyone having a seizure should be rolled
onto the side.
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3. If a child has seizure activity at school,
the parent should be notified as soon as
possible.
4. Growth spurts occur, and medications
will need to be adjusted. Teachers
should be made aware and notify a
parent or guardian if they notice even
mild seizure activity.
TEST-TAKING HINT: Answer 3 can be eliminated because the test taker should recognize the need for full communication between school and home. Also, seizure
activity lasting more than 5 minutes requires medical attention.
86. 1. Tonic-clonic seizures consist of sustained, generalized stiffening of the
muscles in symmetric, rhythmic contractions and relaxations of major
muscle groups. Level of consciousness
is impaired.
2. Absence seizures are characterized by a
blank stare and no muscle activity.
3. Atonic seizures are characterized by an
abrupt loss of tone.
4. Akinetic seizure is another term for atonic
seizure.
5. Myoclonic seizures are characterized by
sudden contractures of a muscle or muscle group.
6. Infantile spasms occur during the first
year of life.
TEST-TAKING HINT: Answer 6 can be eliminated by the age of the child depicted.
87. 1. Infantile seizures occur during the first
year of life.
2. Febrile seizures occur in young children,
usually before 4 years.
3. There is no change in the level of
consciousness; motor symptoms are
evident.
4. No sensory involvement is depicted.
5. Atonic seizures are characterized by an
abrupt loss of tone.
6. Absence seizures are characterized by a
blank stare with no muscle activity.
TEST-TAKING HINT: Answers 1 and 2 can
be eliminated by the age of the patient
depicted.
88. 1. This statement indicates that the parents
understand the potential severe consequences of receiving a second concussion
while recovering from the first one. Football is a contact sport in which there is an
increased risk of concussion. The child
should not participate in contact sports
until cleared by the physician.
2. Short-term memory loss is a frequent
side effect of concussions. Until effects
of the concussion have subsided and
the child is cleared by a physician, the
child should not take school tests that
often rely on short-term memory.
3. Headaches can occur for up to 6 months
after the initial impact. Headaches that
continue to worsen, however, could be
indicative of the development of other
injuries.
4. This statement indicates that the parents
understand the potential severe consequences of receiving a second concussion
while recovering from the first one.
TEST-TAKING HINT: Because answers 1 and
4 have the same rationale, the choice is
further limited to either answer 2 or 3.
89. 1, 2, 3, 6, 7.
1. As the shunt malfunctions and cerebrospinal fluid builds up, the child
will exhibit symptoms of increased
intracranial pressure. Vomiting is one
of the possible signs of increased intracranial pressure.
2. As the shunt malfunctions and cerebrospinal fluid builds up, the child will
exhibit symptoms of increased intracranial pressure. Irritability and
change in neurological status are two
of the possible signs of increased intracranial pressure.
3. As the shunt malfunctions and cerebrospinal fluid builds up, the child will
exhibit symptoms of increased intracranial pressure. Poor feeding is
one of the possible signs of increased
intracranial pressure.
4. As the shunt malfunctions and cerebrospinal fluid builds up, the child will
exhibit symptoms of increased intracranial
pressure. Headache is very difficult to assess in an infant.
5. A sunken fontanel is a sign of dehydration. With increased intracranial pressure,
the brain is edematous and expands in
size. This would result in an enlarged
rather than a sunken fontanel.
6. As the shunt malfunctions and cerebrospinal fluid builds up, the child will
exhibit symptoms of increased intracranial pressure. Seizure is one possible
sign of increased intracranial pressure.
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7. As the shunt malfunctions and cerebrospinal fluid builds up, the child
will exhibit symptoms of increased intracranial pressure. A declining neurological status evidenced by the inability
to wake a child up is one of the possible signs of increased intracranial
pressure.
8. A declining neurological status is a sign of
increased intracranial pressure. Hyperactivity is not a sign of a declining neurological status.
TEST-TAKING HINT: The test taker needs to
know signs of increased intracranial pressure in an infant.
90. Allergies.
Infants should be introduced to solid foods
after 6 months of age. Iron-fortified infant
cereals are recommended first, followed by
the introduction of vegetables, then fruits.
New foods should be introduced about every
3 to 5 days so the caregiver has the opportunity to identify any food allergies the baby
may have.
TEST-TAKING HINT: The question requires
knowledge of the nutritional needs of an
infant as well as the safety concerns that
involve children of this age.
91. Vastus lateralis.
The vastus lateralis muscle can be used for
immunizations of children of all ages. It is a
particularly good choice for infants because it
is the most developed muscle for this age
group. This area is also appealing because it
has few major nerves and blood vessels.
TEST-TAKING HINT: The test taker must
have knowledge of intramuscular injection
sites and acceptable volumes for children
of varying ages.
92. Rear-facing.
An infant should always ride in a rear-facing
car seat until 2 years of age.
TEST-TAKING HINT: The question requires
knowledge of infant safety.
93. Concrete operations.
During the concrete operations stage of cognitive development, the school-aged child is
able to take into account another person’s
point of view. School-aged children are also
able to classify, sort, and organize facts in
order to use them for problem-solving.
TEST-TAKING HINT: The question requires
knowledge of Piaget’s stages of cognitive
development.
94. Toilet-training.
Freud believed that during the anal-urethral
stage of psychosexual development, a child
must achieve toilet-training. Freud believed
that children may have long-lasting difficulties if they do not master toilet-training.
TEST-TAKING HINT: The question requires knowledge of Freud’s stages of
development.
95. Partial or focal seizures.
Seizures originating in both hemispheres are
called generalized seizures.
TEST-TAKING HINT: The question requires
knowledge of names of different seizure
types.
96. Nuchal rigidity.
Nuchal rigidity is assessed when a child has a
fever or appears septic.
TEST-TAKING HINT: The test taker needs to
know how a health-care provider commonly assesses for meningitis.
97. 2, 4.
1. Brain tumors are the most common solid
tumor. Leukemia is the most common
malignancy in the United States.
2. Although an exact cause is unknown,
an association has been linked to
paints and radiation.
3. The manifestations can vary depending
on where the tumor is located.
4. Brain tumors in children usually occur below the cerebellum. Brain tumors in adults usually occur above the
cerebellum.
5. Symptoms of brain tumors can appear
rapidly or slowly, depending on whether
the tumor is fast- or slow-growing.
TEST-TAKING HINT: The test taker can
eliminate answer 1 because brain tumors
are not the most common malignancy in
the United States.
98. 1, 2.
1. Cerebral palsy is the most common
chronic disorder of childhood.
2. There is an increased risk of cerebral
palsy in infants with hyperbilirubinemia.
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PEDIATRIC SUCCESS
3. Cerebral palsy is a nonprogressive chronic
disorder.
4. Approximately 75% of children with cerebral palsy experience learning disabilities.
5. There is no familial tendency seen in
children with cerebral palsy.
TEST-TAKING HINT: The test taker needs
to have a good knowledge of cerebral
palsy.
99. 4, 5.
1. Although it can be caused by a variety of
organisms, encephalitis is usually a viral
infection.
2. Encephalitis is an acute disease.
3. Encephalitis is most commonly seen after
a herpes infection in the newborn population. It is often seen after a varicella
infection in older children.
4. Newborns diagnosed with encephalitis often have extensive neurological
problems.
5. Encephalitis can be seen with
meningitis.
TEST-TAKING HINT: The test taker should
be led to answers 4 and 5 by knowing
that encephalitis is usually viral in origin.
100. 1. Support to grieving families varies with
the needs of the family. General guidelines in support of grieving families are to
deal openly with their feelings and accept
the family’s grief response. Do not avoid
them and avoid judgmental or rationalizing statements. Focus on their feelings.
Provide referral to self-help groups or
professional help if appropriate.
2. Support to grieving families varies with
the needs of the family. General guidelines in support of grieving families are to
deal openly with their feelings and accept
the family’s grief response. Do not avoid
them and avoid judgmental or rationalizing statements. Focus on their feelings.
Provide referral to self-help groups or
professional help if appropriate.
3. Support to grieving families varies with
the needs of the family. General guidelines in support of grieving families are to
deal openly with their feelings and accept
the family’s grief response. Do not avoid
them and avoid judgmental or rationalizing statements. Focus on their feelings.
Provide referral to self-help groups or
professional help if appropriate.
4. Support to grieving families varies
with the needs of the family. General
guidelines in support of grieving families are to deal openly with their feelings and accept the family’s grief response. Do not avoid them and avoid
judgmental or rationalizing statements. Focus on their feelings. Provide referral to self-help groups or
professional help if appropriate.
TEST-TAKING HINT: The test taker should
understand that answers 1, 2, and 3 are
incorrect. General guidelines in support
of grieving families are to deal openly
with their feelings of grief, pain, guilt,
anger, or loss. Stay with the family either
sitting quietly or talking, if they indicate
a need to talk. Avoid offering rationalizations for the child’s terminal illness.
3924_Glossary_313-316 29/11/13 1:42 PM Page 313
Glossary of English Words
Commonly Encountered
on Nursing Examinations
Abnormality — defect, irregularity, anomaly, oddity
Absence — nonappearance, lack, nonattendance
Complex — difficult, multifaceted, compound, multipart,
intricate
Abundant — plentiful, rich, profuse
Complexity — difficulty, intricacy, complication
Accelerate — go faster, speed up, increase, hasten
Component — part, element, factor, section, constituent
Accumulate — build up, collect, gather
Comprehensive — complete, inclusive, broad, thorough
Accurate — precise, correct, exact
Conceal — hide, cover up, obscure, mask, suppress,
secrete
Achievement — accomplishment, success, reaching,
attainment
Acknowledge — admit, recognize, accept, reply
Activate — start, turn on, stimulate
Adequate — sufficient, ample, plenty, enough
Angle — slant, approach, direction, point of view
Application — use, treatment, request, claim
Approximately — about, around, in the region of, more
or less, roughly speaking
Arrange — position, place, organize, display
Associated — linked, related
Attention — notice, concentration, awareness, thought
Authority — power, right, influence, clout, expert
Avoid — keep away from, evade, let alone
Balanced — stable, neutral, steady, fair, impartial
Conceptualize — to form an idea
Concern — worry, anxiety, fear, alarm, distress, unease,
trepidation
Concisely — briefly, in a few words, succinctly
Conclude — make a judgment based on reason, finish
Confidence — self-assurance, certainty, poise,
self-reliance
Congruent — matching, fitting, going together well
Consequence — result, effect, outcome, end result
Constituents — elements, component, parts that make
up a whole
Contain — hold, enclose, surround, include, control, limit
Continual — repeated, constant, persistent, recurrent,
frequent
Barrier — barricade, blockage, obstruction, obstacle
Continuous — constant, incessant, nonstop, unremitting,
permanent
Best — most excellent, most important, greatest
Contribute — be a factor, add, give
Capable — able, competent, accomplished
Capacity — ability, capability, aptitude, role, power, size
Convene — assemble, call together, summon, organize,
arrange
Central — middle, mid, innermost, vital
Convenience — expediency, handiness, ease
Challenge — confront, dare, dispute, test, defy,
face up to
Coordinate — organize, direct, manage, bring together
Characteristic — trait, feature, attribute, quality, typical
Circular — round, spherical, globular
Collect — gather, assemble, amass, accumulate, bring
together
Commitment — promise, vow, dedication, obligation,
pledge, assurance
Create — make, invent, establish, generate, produce,
fashion, build, construct
Creative — imaginative, original, inspired, inventive,
resourceful, productive, innovative
Critical — serious, grave, significant, dangerous,
life-threatening
Cue — signal, reminder, prompt, sign, indication
Commonly — usually, normally, frequently, generally,
universally
Curiosity — inquisitiveness, interest, nosiness, snooping
Compare — contrast, evaluate, match up to, weigh or
judge against
Deduct — subtract, take away, remove, withhold
Compartment — section, part, cubicle, booth, stall
Damage — injure, harm, hurt, break, wound
Deficient — lacking, wanting, underprovided, scarce,
faulty
313
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314
GLOSSARY
OF
ENGLISH WORDS COMMONLY ENCOUNTERED
Defining — important, crucial, major, essential,
significant, central
Defuse — resolve, calm, soothe, neutralize, rescue,
mollify
ON
NURSING EXAMINATIONS
Emerge — appear, come, materialize, become known
Emphasize — call attention to, accentuate, stress,
highlight
Ensure — make certain, guarantee
Delay — hold up, wait, hinder, postpone, slow down,
hesitate, linger
Environment — setting, surroundings, location,
atmosphere, milieu, situation
Demand — insist, claim, require, command, stipulate, ask
Episode — event, incident, occurrence, experience
Describe — explain, tell, express, illustrate, depict,
portray
Essential — necessary, fundamental, vital, important,
crucial, critical, indispensable
Design — plan, invent, intend, aim, propose, devise
Etiology — assigned cause, origin
Desirable — wanted, pleasing, enviable, popular, sought
after, attractive, advantageous
Exaggerate — overstate, inflate
Detail — feature, aspect, element, factor, facet
Deteriorate — worsen, decline, weaken
Determine — decide, conclude, resolve, agree on
Dexterity — skillfulness, handiness, agility, deftness
Dignity — self-respect, self-esteem, decorum, formality,
poise
Dimension — aspect, measurement
Excel — to stand out, shine, surpass, outclass
Excessive — extreme, too much, unwarranted
Exertion — intense or prolonged physical effort
Exhibit — show signs of, reveal, display
Expand — get bigger, enlarge, spread out, increase,
swell, inflate
Expect — wait for, anticipate, imagine
Diminish — reduce, lessen, weaken, detract, moderate
Expectation — hope, anticipation, belief, prospect,
probability
Discharge — release, dismiss, set free
Experience — knowledge, skill, occurrence, know-how
Discontinue — stop, cease, halt, suspend, terminate,
withdraw
Expose — lay open, leave unprotected, allow to be seen,
reveal, disclose, exhibit
Disorder — complaint, problem, confusion, chaos
External — outside, exterior, outer
Display — show, exhibit, demonstrate, present,
put on view
Facilitate — make easy, make possible, help, assist
Dispose — to get rid of, arrange, order, set out
Dissatisfaction — displeasure, discontent, unhappiness,
disappointment
Distinguish — to separate and classify, recognize
Distract — divert, sidetrack, entertain
Distress — suffering, trouble, anguish, misery, agony,
concern, sorrow
Distribute — deliver, spread out, hand out, issue,
dispense
Factor — part, feature, reason, cause, think, issue
Focus — center, focal point, hub
Fragment — piece, portion, section, part, splinter, chip
Function — purpose, role, job, task
Furnish — supply, provide, give, deliver, equip
Further — additional, more, extra, added, supplementary
Generalize — to take a broad view, simplify, to make
inferences from particulars
Generate — make, produce, create
Disturbed — troubled, unstable, concerned, worried,
distressed, anxious, uneasy
Gentle — mild, calm, tender
Diversional — serving to distract
Highest — uppermost, maximum, peak, main
Don — put on, dress oneself in
Hinder — hold back, delay, hamper, obstruct, impede
Dramatic — spectacular
Humane — caring, kind, gentle, compassionate,
benevolent, civilized
Drape — cover, wrap, dress, swathe
Dysfunction — abnormal, impaired
Edge — perimeter, boundary, periphery, brink, border,
rim
Girth — circumference, bulk, weight
Ignore — pay no attention to, disregard, overlook,
discount
Imbalance — unevenness, inequality, disparity
Effective — successful, useful, helpful, valuable
Immediate — insistent, urgent, direct
Efficient — not wasteful, effective, competent, resourceful,
capable
Impair — damage, harm, weaken
Elasticity — stretch, spring, suppleness, flexibility
Impotent — powerless, weak, incapable, ineffective,
unable
Eliminate — get rid of, eradicate, abolish, remove,
purge
Embarrass — make uncomfortable, make self-conscious,
humiliate, mortify
Implantation — to put in
Inadvertent — unintentional, chance, unplanned,
accidental
Include — comprise, take in, contain
3924_Glossary_313-316 29/11/13 1:42 PM Page 315
GLOSSARY
OF
ENGLISH WORDS COMMONLY ENCOUNTERED
ON
NURSING EXAMINATIONS
Indicate — point out, sign of, designate, specify, show
Obsess — preoccupy, consume
Ineffective — unproductive, unsuccessful, useless, vain,
futile
Occupy — live in, inhabit, reside in, engage in
Inevitable — predictable, to be expected, unavoidable,
foreseeable
Odorous — scented, stinking, aromatic
Influence — power, pressure, sway, manipulate, affect,
effect
Opportunity — chance, prospect, break
Initiate — start, begin, open, commence, instigate
Insert — put in, add, supplement, introduce
Occurrence — event, incident, happening
Offensive — unpleasant, distasteful, nasty, disgusting
Organize — put in order, arrange, sort out, categorize,
classify
Inspect — look over, check, examine
Origin — source, starting point, cause, beginning,
derivation
Inspire — motivate, energize, encourage, enthuse
Pace — speed
Institutionalize — to place in a facility for treatment
Parameter — limit, factor, limitation, issue
Integrate — put together, mix, add, combine, assimilate
Participant — member, contributor, partaker, applicant
Integrity — honesty
Perspective — viewpoint, view, perception
Interfere — get in the way, hinder, obstruct, impede,
hamper
Position — place, location, point, spot, situation
Interpret — explain the meaning of, to make
understandable
Intervention — action, activity
Intolerance — bigotry, prejudice, narrow-mindedness
Involuntary — instinctive, reflex, unintentional,
automatic, uncontrolled
Irreversible — permanent, irrevocable, irreparable,
unalterable
Irritability — sensitivity to stimuli, fretful, quick
excitability
Justify — explain in accordance with reason
Likely — probably, possible, expected
Liquefy — to change into or make more fluid
Logical — using reason
Longevity — long life
Practice — do, carry out, perform, apply, follow
Precipitate — to cause to happen, to bring on, hasten,
abrupt, sudden
Predetermine — fix or set beforehand
Predictable — expected, knowable
Preference — favorite, liking, first choice
Prepare — get ready, plan, make, train, arrange,
organize
Prescribe — set down, stipulate, order, recommend,
impose
Previous — earlier, prior, before, preceding
Primarily — first, above all, mainly, mostly, largely,
principally, predominantly
Primary — first, main, basic, chief, most important, key,
prime, major, crucial
Lowest — inferior in rank
Priority — main concern, giving first attention to, order
of importance
Maintain — continue, uphold, preserve, sustain, retain
Production — making, creation, construction, assembly
Majority — the greater part of
Profuse — a lot of, plentiful, copious, abundant,
generous, prolific, bountiful
Mention — talk about, refer to, state, cite, declare,
point out
Prolong — extend, delay, put off, lengthen, draw out
Minimal — least, smallest, nominal, negligible, token
Promote — encourage, support, endorse, sponsor
Minimize — reduce, diminish, lessen, curtail, decrease
to smallest possible
Proportion — ratio, amount, quantity, part of, percentage,
section of
Mobilize — activate, organize, assemble, gather
together, rally
Provide — give, offer, supply, make available
Modify — change, adapt, adjust, revise, alter
Realistic — practical, sensible, reasonable
Moist — slightly wet, damp
Receive — get, accept, take delivery of, obtain
Multiple — many, numerous, several, various
Recognize — acknowledge, appreciate, identify, aware of
Natural — normal, ordinary, unaffected
Recovery — healing, mending, improvement,
recuperation, renewal
Negative — no, harmful, downbeat, pessimistic
Rationalize — explain, reason
Negotiate — bargain, talk, discuss, consult, cooperate,
settle
Reduce — decrease, lessen, ease, moderate, diminish
Notice — become aware of, see, observe, discern, detect
Regard — consider, look upon, relate to, respect
Notify — inform, tell, alert, advise, warn, report
Regular — usual, normal, ordinary, standard, expected,
conventional
Nurture — care for, raise, rear, foster
Reestablish — reinstate, restore, return, bring back
315
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316
GLOSSARY
OF
ENGLISH WORDS COMMONLY ENCOUNTERED
ON
NURSING EXAMINATIONS
Relative — comparative, family member
Source — basis, foundation, starting place, cause
Relevance — importance of
Specific — exact, particular, detail, explicit, definite
Reluctant — unwilling, hesitant, disinclined, indisposed,
adverse
Stable — steady, even, constant
Reminisce — to recall and review remembered
experiences
Subtract — take away, deduct
Remove — take away, get rid of, eliminate, eradicate
Reposition — move, relocate, change position
Statistics — figures, data, information
Success — achievement, victory, accomplishment
Surround — enclose, encircle, contain
Require — need, want, necessitate
Suspect — think, believe, suppose, guess, deduce, infer,
distrust, doubtful
Resist — oppose, defend against, keep from, refuse to
go along with, defy
Sustain — maintain, carry on, prolong, continue,
nourish, suffer
Resolution — decree, solution, decision, ruling, promise
Synonymous — same as, identical, equal, tantamount
Resolve — make up your mind, solve, determine, decide
Systemic — affecting the entire organism
Response — reply, answer, reaction, retort
Thorough — careful, detailed, methodical, systematic,
meticulous, comprehensive, exhaustive
Restore — reinstate, reestablish, bring back, return to,
refurbish
Restrict — limit, confine, curb, control, contain, hold
back, hamper
Retract — take back, draw in, withdraw, apologize
Reveal — make known, disclose, divulge, expose, tell,
make public
Review — appraisal, reconsider, evaluation, assessment,
examination, analysis
Ritual — custom, ceremony, formal procedure
Tilt — tip, slant, slope, lean, angle, incline
Translucent — see-through, transparent, clear
Unique — one and only, sole, exclusive, distinctive
Universal — general, widespread, common,
worldwide
Unoccupied — vacant, not busy, empty
Unrelated — unconnected, unlinked, distinct, dissimilar,
irrelevant
Rotate — turn, go around, spin, swivel
Unresolved — unsettled, uncertain, unsolved, unclear,
in doubt
Routine — usual, habit, custom, practice
Utilize — make use of, employ
Satisfaction — approval, fulfillment, pleasure, happiness
Various — numerous, variety, range of, mixture of,
assortment of
Satisfy — please, convince, fulfill, make happy, gratify
Secure — safe, protected, fixed firmly, sheltered,
confident, obtain
Sequential — chronological, in order of occurrence
Verbalize — express, voice, speak, articulate
Verify — confirm, make sure, prove, attest to, validate,
substantiate, corroborate, authenticate
Significant — important, major, considerable,
noteworthy, momentous
Vigorous — forceful, strong, brisk, energetic
Slight — small, slim, minor, unimportant, insignificant,
insult, snub
Withdraw — remove, pull out, take out, extract
Volume — quantity, amount, size
3924_Index_317-328 29/11/13 1:42 PM Page 317
Index
A
ABO blood incompatibility, 299
Absence seizures, 78, 88, 293, 310
Absolute neutrophil count, 121, 130
Abstinence, 12, 24
Accutane. See Isotretinoin
Acetaminophen, 34, 47, 270, 278
Acne, 267, 275
Acquired heart disease, 101, 108
Activated charcoal, 35, 47
Acute adrenocortical insufficiency, 179, 190
Acute asthma attack, 269, 278
Acute hepatitis, 140, 141, 150
Acute lymphoblastic leukemia, 120, 121, 128, 129, 130, 131
Acute renal failure
chronic renal failure versus, 164, 173, 174
fluid therapy for, 165, 174
peritoneal dialysis for, 165, 174
treatment of, 165, 174
Acute spasmodic laryngitis, 289, 305
Addison disease, 179, 180, 190, 191
Adolescent
abstinence teaching to, 12, 24
anticipatory guidance in, 34, 46
behavioral changes in, 14, 25
diabetes mellitus in, 13, 25, 185, 197, 198
epilepsy in, 79, 89
growth and development of, 12–14, 23–25
gynecomastia in, 13, 24–25
headache in, 201, 211
health information from, 12, 23
injury prevention for, 32, 44
judgment by, 13, 24
nutrition in, 13, 14, 25
prenatal testing in, 282, 297
psychosocial development of, 12, 23
sexually transmitted diseases in, 13, 24
sleeping by, 13, 25
slipped capital femoral epiphysis in, 221, 231
smoking prevention in, 290, 306
spinal cord injury in, 202, 207, 211, 212, 218
systemic lupus erythematosus in, 13, 24
well-care visit of, 34, 46
Adoption, 281, 296
Adrenal cortex, 181, 192
Adrenal insufficiency, 183, 194
Adrenocortical insufficiency, acute, 179, 190
Advil, 264, 272
Advocacy, patient, 239, 249
Akinetic seizures, 293, 310
Albuterol, 54, 65, 269, 278
Allergies
cow’s milk, 283, 299
latex, 102, 110, 203, 213, 287, 303
Allopurinol, 121, 131
All-terrain vehicles, 33, 45
Altered consciousness, 76, 84, 85, 94, 95
Ambiguous genitalia, 179, 182, 190, 193
Amoxicillin (Amoxil), 56, 67, 265, 267, 268, 272, 275, 276
Amphotericin B, 265, 272
Amputation, 225, 234
Analgesics
opioid, 223, 233
sickle cell pain crisis managed with, 118, 127
Androgens, 181, 192
Anemia
aplastic, 119, 128
Cooley, 119, 128
in infants, 7, 17
iron deficiency, 7, 17
sickle cell. See Sickle cell anemia
in toddlers, 8, 18
Anorectal malformation, 144, 154
Anovulation, 290, 306
Anterior fontanel, 7, 16, 136, 146
Anterior pituitary gland, 181, 192
Antibiotics
allergic reaction to, 241, 251
dosing of, 269, 278
prophylactic, 101, 109
Anticipatory guidance in adolescents, 34, 46
Anticonvulsants, 79, 88, 89
Antidiuretic hormone, 181, 192
Antiminth. See Pyrantel pamoate
Antiretroviral medications, 118, 126
Antithyroid drugs, 186, 198
Anus, imperforate, 144, 154
Aortic stenosis, 103, 111
Aplastic anemia, 119, 128
Appendectomy, 140, 149
Appendicitis, 139, 149
Appendix, 140, 149
Arab culture, 283
Arnold-Chiari malformation, 287, 303
Arthritis
juvenile idiopathic, 227, 236
septic, 221, 223, 231, 232
Aspiration, 7, 17
Aspiration pneumonia, 59, 72, 83, 93
Aspirin
Kawasaki disease treated with, 102, 109
Pepto-Bismol and, 292, 309
Reye syndrome caused by, 78, 87, 109, 110
rheumatic fever treated with, 104, 112
Assault and battery, 247, 260
Assent, 246, 258
Asthma
acute exacerbation of, 54, 64
albuterol for, 54, 65
317
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318
INDEX
breathing exercises for, 55, 65
case management of, 240, 250
description of, 305
home environment considerations for, 55, 65–66
montelukast for, 290, 306, 307
nebulizer for, 248, 261
prioritizing of patients with, 54, 65
sports participation and, 54, 65
Asthma attack, acute, 269, 278
Atlantoaxial instability, 291, 307
Atonic seizures, 78, 88, 293, 310
Atrial septal defect, 288, 304
Atropine, 270, 271, 279
Attention deficit-hyperactivity disorder, 289, 305, 306
Autism, 283, 298, 299
Autonomic dysreflexia, 201, 208, 211, 218
Autonomy, 245, 256
Azotorrhea, 52, 61
B
Baclofen, 83, 93, 204, 215, 267, 276
Bacterial meningitis, 28, 37, 77, 86
Bacterial tracheitis, 289, 305
Basal metabolic index, 287, 302
Bed-wetting, 162, 171, 172
Benadryl. See Diphenhydramine
Beneficence, 290, 307
Benzoyl peroxide, 267, 275
Beta blockers, 102, 109
Beta-thalassemia, 119, 128
Bicycle safety, 12, 22
Biliary atresia, 141, 151
Biopsy, excisional, 226, 235
Birth weight
doubling of, 8, 17
loss of, 6, 16
Bladder
capacity of, 158, 167
exstrophy of, 161, 170, 171
neurogenic, 81, 91
Bleeding
in hemophilia patients, 116, 119, 125, 127
in von Willebrand patients, 119, 127, 128
Blindness, 283, 298
Blood glucose testing, 184, 195
Blood pressure
end-organ damage evaluations, 100, 107
hydronephrosis effects on, 162, 171
percentile determinations, 286, 302
Blood pressure measurement
child’s cooperation with, 10, 20
upper and lower extremity, 101, 108, 109
Blood transfusion, 117, 125, 298
Blood types, 284, 299
Bloody diarrhea, 138, 148
Blunt ocular trauma, 33, 45
Body image disturbances, 121, 130
Bone, 225, 234
Bone age, 179, 189
Bone marrow aspiration, 120, 129
Bone marrow transplant, 226, 235
Brace
for cerebral palsy, 83, 93
for scoliosis, 223, 233
Brachial plexus injury, 207, 218
Brachycephaly, positional, 82, 92
Brain tumors, 84, 94, 295, 311
Breach of duty of care, 247, 259
Breastfeeding
frequency of, 136, 146
maternal education about, 6, 15
outcomes of, 281, 296
Breathing exercises for asthma, 55, 65
Brudzinski sign, 77, 86
C
Calcaneus bone, 225, 234
Car seats, 7, 16, 295, 311
Carbamazepine, 267, 276
Carbon monoxide poisoning, 34, 46
Cardiac catheterization, 98, 101, 102, 105, 109, 110
Cardiovascular disorders, 97–113
Cardizem. See Diltiazem
Case management outcomes, 240, 250
Cast
clubfoot treated with, 222, 231
spica, 222, 223, 231, 233
Casts, 32, 44
Celiac disease, 144, 154
Cellulitis, 269, 277
Central nervous system, 120, 129
Cephalexin, 269, 277
Cerebral palsy
aspiration pneumonia associated with, 59, 72, 83, 93
baclofen for, 83, 93, 204, 215, 267, 276
braces for, 83, 93
communication methods, 83, 93
features of, 295, 311, 312
feeding considerations, 83, 93
follow-up for, 82, 92
G-tubes for, 83, 93
incidence of, 82, 92
long-term needs for, 204, 215
mental retardation and, 205, 216
nursing diagnosis for, 205, 215, 216
parent teaching and education about, 83, 93, 204,
214, 215
plan of care for, 203, 214
priority nursing goals for, 203, 214
risk factors for, 82, 92
sign language and, 83, 93
spastic, 204, 215, 267, 276
speech therapy in, 83, 92, 93
in toddlers, 204, 214
Cerebrospinal fluid
bacterial meningitis diagnosis, 77, 86
cloudy, 77, 86
Cervical collar, 84, 94
Cervical fracture, 84, 94
Cervical spine, 207, 218
Change-of-shift report, 244, 255
Charge nurse, 248, 261
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INDEX
Chelation therapy, 119, 128, 266, 274
Chemotherapy
acute lymphoblastic leukemia treated with, 120, 129
body image disturbances secondary to, 121, 130
Ewing sarcoma treated with, 226, 234, 235
juvenile idiopathic arthritis treated with, 227, 236
mechanism of action, 121, 131
nausea and vomiting caused by, 117, 120, 126, 130
neutropenia secondary to, 225, 234
parent teaching and education about, 120, 129
Chest physiotherapy, for cystic fibrosis, 52, 61
Chickenpox, 28, 38, 121, 130, 285, 302
Child abuse
definition of, 35, 47
description of, 36, 49
information gathering about, 9, 19
injury and deaths caused by, 7, 16
Munchausen syndrome by proxy, 35, 47–48
priority nursing interventions for, 36, 48–49
sexual, 35, 48
shaken baby syndrome, 36, 49, 80, 90
signs and symptoms of, 35, 48
therapeutic communication for, 35, 48
Chinese culture, 283
Chlamydial pneumonia, 289, 305
Chlorhexidine, 267, 275
Chloride, 60, 73
Choking, 59, 72, 73
Cholestyramine, 141, 151
Chordee repair, 160, 169
Chorea, 110
Chores, 12, 23
Chronic renal failure
acute renal failure versus, 164, 173, 174
chronic hypertension in, 166, 175
dietary considerations, 166, 175
electrolyte imbalance in, 166, 175
secondary hyperparathyroidism caused by, 189
Chvostek sign, 181, 193
Ciprofloxacin (Cipro), 267, 275
Circumcision, 160, 169
Cleft lip and palate, 141, 151, 152, 288, 303
Closed-head injury, 79, 80, 89
Clubfoot, congenital
casting for, 222, 231
parent teaching and education about, 220, 222, 223, 229,
231, 233
surgery for, 222, 232
Coarctation of the aorta, 101, 103, 109, 111
Cognitive development, 284, 300
Collagenase, 267, 275
Colostomy, 144, 154
Communication
with cerebral palsy patients, 83, 93
with deaf parents, 283, 298
Compact bone, 225, 234
Compartment syndrome, 228, 237
Concrete operations, 311
Concussion, 33, 44–45, 283, 294, 299, 310
Confidentiality, 245, 246, 257, 258
Congenital, 282
Congenital clubfoot. See Clubfoot, congenital
Congenital heart defects
cardiac demands in patients with, 98, 106
classification of, 99, 107
coarctation of the aorta, 101, 103, 109, 111
hypoplastic left heart syndrome, 98, 104, 112
hypoxic spells in, 100, 107
indomethacin for, 98, 106
Norwood procedure, 102, 109
patent ductus arteriosus, 98, 99, 103, 105, 106, 111
tetralogy of Fallot, 98, 99, 100, 104, 105, 107, 112
transposition of the great vessels, 103, 111, 270, 279
upper and lower extremity blood pressure measurements,
101, 108
ventricular septal defect, 103, 110, 111
Congenital hypothyroidism, 30, 40
Congestive heart failure
digoxin for, 243, 253, 254
hypoxemia in, 104, 111
management of, 101, 108
nutrition in, 102, 110
signs and symptoms of, 101, 108
treatment of, 103, 104, 110, 113
Conjunctivitis, 268, 276
Consciousness
altered, 76, 84, 85, 94, 95
level of, 33, 44
state of, 76, 85
Constipation
causes of, 145, 156
in cystic fibrosis, 52, 62
management of, 138, 147
pharmacologic treatment of, 138, 147
in Werdnig-Hoffman disease, 206, 218
Continuity of care, for premature infants, 243, 254
Contraception, 228, 237
Cooley anemia, 119, 128
Corrosives, 34, 46
Corticosteroids
juvenile idiopathic arthritis treated with, 227, 236
side effects of, 227, 236
Cortisol, 179, 181, 190, 192
Cortisone, 179, 180, 190
Cough, 57, 69
Cow’s milk allergy, 283, 299
Craniosynostosis, 82, 91, 92
Croup, 58, 71
Crutch bar, 222, 232
Cuban culture, 283
Culture, 283, 298
Cushing syndrome, 181, 187, 192, 198
Cushing triad, 86, 89
Cutis marmorata, 284, 299
Cyclophosphamide, 227, 266, 273
Cystic fibrosis
antibiotics for, 269, 278
chest physiotherapy for, 52, 61
chloride levels and, 60, 73
constipation associated with, 52, 62
diagnosis of, 60, 73
double lung transplant for, 52, 62
319
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inheritance pattern of, 52, 61
life expectancy for, 53, 62
in newborn, 29, 39
nutritional needs in, 52, 61–62
parental information about, 53, 62
probability of having second child with, 282, 297
respiratory symptoms of, 52, 62
stool analysis in, 52, 61
treatment of, 60, 73
Cytoxan. See Cyclophosphamide
D
Dalteparin sodium, 266, 274
Day care, 282, 297
Deafness, 283, 298
Decadron. See Dexamethasone
Decorticate posturing, 78, 87
Deferoxamine, 266, 274
Dehydration
diagnosis of, 136, 146
fluids for, 145, 155
treatment of, 136, 137, 146
Delegation of tasks, 243, 244, 254, 255
Dental visits, 285, 301
Denver Developmental Screening Test, 10, 20
Desferal. See Deferoxamine
Desmopressin acetate, 183, 194
Desoxycorticosterone acetate, 179, 190
Development
cognitive, 284, 300
Piaget’s stages of, 285, 295, 300, 311
psychosocial, 12, 23
of toddlers, 9, 18
Developmental delays, 8, 17
Developmental dysplasia of the hip, 219, 220, 229, 233, 288, 303
Dexamethasone, 267, 276
Dextrose, 271, 280
Diabetes insipidus
desmopressin acetate for, 183, 194
fluid restrictions for, 179, 184, 189, 196
monitoring of, 178, 188
nursing education about, 184, 196
parent teaching and education about, 179, 185, 189, 196
Diabetes mellitus
in adolescent, 13, 25
in adolescents, 185, 197, 198
insulin for, 184, 195
metformin for, 185, 197
type 1, 183, 184, 185, 195, 197, 198, 247, 260
type 2, 184, 185, 187, 196, 197, 198
Dialysis
hemodialysis, 166, 175
peritoneal, 165, 174, 175
Diaper dermatitis, 288, 303
Diaphysis, 225, 234
Diarrhea
bloody, 138, 148
management of, 137, 147
rotavirus as cause of, 137, 147
Diclofenac, 266, 267, 274, 276
Diet. See also Nutrition
for celiac disease, 144, 154
for chronic renal failure, 166, 175
for cystic fibrosis, 52, 61–62
for hepatitis, 140, 150
for infant, 294, 311
ketogenic, 79, 88
after tonsillectomy, 54, 64
Digoxin
administration of, 98, 105
congestive heart failure treated with, 243, 253, 254
dosing of, 267, 270, 275, 278
parent teaching and education about, 98, 105
toxicity of, 34, 46, 101, 108, 253, 270, 278
Dilantin. See Phenytoin
Diltiazem, 266, 274
Diphenhydramine, 28, 31, 38, 42, 269, 277
Dipyridamole, 102, 109
Discharge instructions and teaching
appendectomy, 140, 150
beta-thalassemia, 119, 128
bladder exstrophy, 161, 170, 171
continuity of care for premature infant, 243, 254
encopresis, 138, 148
epispadias repair, 160, 169
febrile seizures, 79, 88
gastrostomy tube, 142, 152
growth hormone therapy, 266, 273
imperforate anus, 144, 154
Kawasaki disease, 104, 113
parathyroidectomy, 183, 195
shunt for hydrocephalus, 294, 310, 311
social problems that affect, 240, 250
systemic lupus erythematosus, 292, 309
Distraction, 11, 22
Ditropan. See Oxybutynin
Divorce, 281, 296, 297
Double effect, 290, 307
Double lung transplant, 52, 62
Down syndrome, 102, 109, 291, 307
Drawings, 11, 21
DTaP vaccine, 30, 41, 206, 218
Duchenne muscular dystrophy, 200, 209
Dysfluency, 283, 298
Dysrhythmias, 100, 102, 107, 110
E
Ear infections, 56, 57, 67, 68, 289, 304, 305. See also Otitis
media
Ear tubes, 56, 68
Eardrops, 268, 276
Eczema, 269, 277
Edema, 159, 169
Education, maternal, 6, 15
Egocentricity, 18–19
Electrocardiogram, 97, 105
Emancipation, 246, 258
Emergency medical treatment, 57, 69, 70
EMLA cream, 180, 191, 288, 303, 304
Encephalitis
features of, 295, 312
interventions for, 29, 38–39, 78, 87
viral, 78, 87
Encopresis, 138, 148
Endocrine disorders, 177–198
Endocrine glands, 187, 198
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End-organ damage, 100, 107
Enema, 143, 153
Enterocolitis, 145, 148, 155
Enuresis, 162, 171, 289, 305
Epiglottitis, 58, 70, 71
Epilepsy, 79, 88, 89
Epinephrine, 31, 42
Epiphyseal plate, 225, 234
Epiphysis, 225, 234
Epispadias, 160, 169
Equality, 245, 256
Erb palsy, 284, 299
Erythema infectiosum, 28, 38
Erythromycin, 270, 279
Esophageal atresia, 142, 152
Estrogen, 181, 192
Ethical issues, 245, 256
Ethical principles, 245, 256, 290, 307
Ethics committee, 245, 257
Ewing sarcoma, 226, 234, 235
Exchange transfusion
reaction to, 284, 300
sickle cell anemia treated with, 118, 127
Excisional biopsy, 226, 235
Exophthalmic goiter, 187, 198
Extrapyramidal side effects, 290, 306
Eye ointment, 268, 276
F
Factor VIII deficiency, 118, 127
Failure to thrive, 10, 21
Falls, 11, 21, 32, 43
Family-centered care, 240, 250
Febrile seizures, 79, 88, 294, 310
Feeding. See also Nutrition
of cerebral palsy patients, 83, 93
gavage, 104, 111
Fever, 266, 274
Fidelity, 245, 256
Fifth disease, 28, 38, 285, 302
Filgrastim, 266, 274
FISH analysis, 282
Fistula, tracheoesophageal, 142, 152
FLACC scale, 7, 17
Fluids
for acute renal failure, 165, 174
for dehydration, 145, 155
Focal seizures, 311
Folic acid, 287, 302
Followership, 242, 252
Fontanels, 7, 16, 136, 146
Foramen ovale, 108
Foreign bodies
choking on, 59, 72, 73
in eye, 283, 298
ingestion of, 34, 46
parent teaching about aspiration of, 60, 73
Fractures
cervical, 84, 94
greenstick, 228, 237
skull, 80, 90
tibia, 228, 237
Fragmin. See Dalteparin sodium
Furosemide, 269, 277
G
Galactosemia
interventions for, 29, 40
parent teaching and education about, 30, 40
Gamma globulin, 104, 112, 268, 270, 277, 279
Gastroesophageal reflux, 139, 148, 149
Gastrointestinal disorders, 135–156
Gastroschisis, 288, 303
Gastrostomy tube, 142, 152
Gavage feeding, 104, 111
Generalized seizures, 293, 309, 310
Generalized tonic-clonic seizure
in meningitis, 78, 87
treatment of, 293, 309
Genetic counseling, 30, 40
Genetic screening, for muscular dystrophy, 200, 210
Genitalia, ambiguous, 179, 182, 190, 193
Genitourinary disorders, 157–176
Genome, 282
Gentamicin, 265, 273
Global organization, 285, 300, 301
Glomerulonephritis, 158, 159, 168
Glucophage. See Metformin
Goiter, 186, 187, 198
Gonadotropins, 181, 192
Good Samaritan act, 259
Gower sign, 200, 209
Graves disease, 178, 183, 185, 186, 188, 189, 194, 195, 197, 198
Greenstick fracture, 228, 237
Growth and development, 5–25
Growth hormone
deficiency of, 180, 191
discharge teaching for, 266, 273
short stature treated with, 265, 273
G-tubes, 83, 93
Guillain-Barré syndrome, 206, 217, 292, 308
G-Well. See Lindane
Gynecomastia, 13, 24–25
H
Haitian culture, 283
Haloperidol (Haldol), 290, 306
Head
circumference measurements of, 81, 91
closed-head injury, 79, 80, 89
trauma to, 79, 80, 89
Headache, 201, 211
Health information
confidentiality of, 245, 257
individually identifiable, 242, 246, 253, 258
staff access to, 246, 257
Health-care beliefs, 283, 298
Health-care consumers, 241, 250
Heart murmurs, 99, 106
Heart sounds, 288, 304
Heart transplant, 104, 112
Heel-stick blood sampling, 284, 300
Height measurements, 10, 20
Helmet, for positional brachycephaly, 82, 92
321
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Hematological disorders, 115–133
Hematuria, 160, 170
Hemodialysis, 166, 175
Hemoglobin A1c test, 184, 196
Hemolytic reactions, 117, 125
Hemolytic uremic syndrome, 160, 169, 170
Hemophilia
bleeding management in, 116, 119, 125, 127
causes of, 119, 127
diagnosis of, 118, 127
parent teaching and education about, 119, 127
sports participation considerations, 117, 125
Hepatitis
acute, 140, 141, 150
B, 7, 16, 31, 32, 42, 43
dietary considerations, 140, 150
Hernia
incarcerated, 163, 172, 173
inguinal, 163, 172
umbilical, 142, 143, 152, 153
Hib vaccine, 31, 41–42
Hibiclens. See Chlorhexidine
HIPAA regulations, 257, 259
Hirschsprung disease, 138, 148
HIV
antiretroviral medications for, 118, 126
diagnosis of, 118, 123, 126, 133
immunizations in patients with, 29, 38, 123, 133
laboratory tests for, 123, 133
opportunistic infections in, 123, 133
Hodgkin disease, 122, 131
Home care
asthma, 55, 65–66
individualized, 241, 251
upper respiratory infection, 56, 67
Homelessness, 240, 250
Hospitalization
for bacterial meningitis, 77, 86
for croup, 58, 71
for pneumonia, 59, 72
of preschooler, 9, 10, 19, 21
for respiratory syncytial virus, 57, 69
of toddlers, 8–9, 18–19
Humalog insulin, 266, 273
Hydrocele, 163, 172
Hydrocephalus
myelomeningocele and, 203, 213, 214
shunt placement for, 291, 294, 308, 310, 311
signs and symptoms of, 291, 307
treatment of, 291, 307, 308
Hydrocortisone, 269, 277
Hydronephrosis, 162, 171
Hyperparathyroidism, secondary, 189
Hypertension
in chronic renal failure, 166, 175
secondary, 100, 108
treatment of, 100, 108
Hyperthyroidism, 184, 186, 196, 198
Hypocalcemia, 178, 189
Hypoglycemia, 264, 272
Hypopituitarism, 181, 184, 196
Hypoplastic left heart syndrome, 98, 104, 112
Hypospadias, 160, 169
Hypothyroidism
congenital, 30, 40
levothyroxine for, 265, 273
Hypoxemia, 84, 94, 104, 111
Hypoxic spells, 100, 107
I
Ibuprofen, 264, 272
Idiopathic thrombocytopenia purpura, 117, 119, 125, 128, 270
Ifosfamide, 266, 274
Immunizations
DTaP, 30, 41, 206, 218
fever and, 266, 274
after gamma globulin administration, 104, 112
governing organizations for, 288, 303
hepatitis B, 7, 16, 32, 43
Hib, 31, 41–42
in HIV patients, 29, 38, 123, 133
influenza, 55, 66
injection site for, 294, 311
IPV, 31, 42
nursing interventions before administration of, 31, 41
in preschoolers, 9, 20, 288, 303, 304
rotavirus, 32, 43
tetanus, 292, 309
varicella, 7, 16, 30, 41
Immunoglobulin G, 99, 106
Immunological disorders, 115–133
Imperforate anus, 144, 154
Incarcerated hernia, 163, 172, 173
Incident report, 257
Increased intracranial pressure
in brain tumors, 84, 94
in infants, 76, 85
in Reye syndrome, 87
in skull fracture, 80, 90
Individualized home care, 241, 251
Individually identifiable health information, 242, 246,
253, 258
Indomethacin, 98, 106, 270, 279
Industry, 11, 22
Infant. See also Newborn; Premature infant; Toddler
anemia in, 7, 17
cardiac catheterization in, 98, 105, 106
clubfoot in, 220, 229
dehydration in, 136, 146
developmental milestones in, 204, 214, 215
feeding of, 142, 152, 294, 311
gastroesophageal reflux in, 139, 148, 149
hydrocephalus in, 291, 307
increased intracranial pressure in, 76, 85
injury and deaths, 7, 16–17
iron deficiency anemia in, 7, 17
myelomeningocele in, 202, 212
pain assessment in, 7, 8, 17
parent and, trust relationship between, 6, 15
physical assessment of, 7, 16
respiratory distress in, 57, 69
seizure in, 80, 90
solid foods for, 294, 311
toys for, 6, 16
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INDEX
weighing of, 5, 8, 15, 17, 28, 37
weight loss in, 6, 16
Infantile spasm, 293, 294, 310
Influenza, 55, 56, 66, 67, 183, 194
Informed consent, 246, 258, 259
Inguinal hernia, 163, 172
Injections
insulin, 184, 195
intramuscular, 6, 15, 180, 191
Injury
assessments after, 33, 44
closed-head, 79, 80, 89
Injury prevention
for adolescent, 32, 44
for newborn, 32, 43
Innocent murmur, 288, 304
Insulin
Humalog, 266, 273
NPH, 264, 272
self-administration of, 184, 195
Insulin-to-carbohydrate ratio, 185, 197
Intellectual initiative, 10, 20
Interdisciplinary team, 241, 251
Interpreters, 283, 298
Intracranial pressure, increased. See Increased intracranial
pressure
Intramuscular injections, 6, 15, 180, 191
Intussusception, 143, 144, 153, 154
IPV immunization, 31, 42
Iron
food sources of, 18
premature infant requirements for, 6, 15
Iron deficiency anemia, 7, 17
Isotretinoin, 267, 275
J
Jehovah’s Witnesses, 282, 298
Justice, 245, 256, 290, 307
Juvenile idiopathic arthritis, 227, 236
K
Kasai procedure, 141, 151
Kawasaki disease
aspirin therapy for, 102, 109
complications of, 99, 106
dipyridamole for, 102, 109
family discharge teaching for, 104, 113
laboratory tests for, 243, 253
priority nursing intervention for, 28, 37
in toddlers, 104, 113
treatment of, 99, 106
Keflex. See Cephalexin
Kernig sign, 86
Ketogenic diet, 79, 88
Kidney dialysis, 36, 49
Kidney failure. See Acute renal failure; Chronic renal failure
Kidney removal, 164, 173
Kidney transplantation, 166, 175
Kwell. See Lindane
L
Lamisil. See Terbinafine
Lanoxin. See Digoxin
Laryngotracheobronchitis, 289, 305
Lasix. See Furosemide
Latex allergies, 102, 110, 203, 213, 287, 303
Lead, 33, 46, 286, 302
Leadership, 239–261
Left-sided pneumonia, 59, 72
Legal authority, 247, 259
Legal blindness, 283, 298
Leukemia
absolute neutrophil count in, 121, 130
acute lymphoblastic, 120, 121, 128, 129, 130, 131
allopurinol for, 121, 131
central nervous system protection against, 120, 129
chickenpox exposure in patient with, 121, 130
complications of, 117, 125
cyclophosphamide for, 266, 274
ifosfamide for, 266, 274
late effect of, 122, 131
lumbar puncture for, 117, 125, 126
manifestations of, 117, 126
prednisone for, 121, 131
prognostic factors, 121, 130, 131
Leukotriene modifiers, 290, 306, 307
Level of consciousness, 33, 44
Levothyroxine, 265, 273
Lice, 289, 305
Licensed practical nurse, 243, 254, 255
Licensed vocational nurse, 243, 254, 255
Lindane, 267, 268, 275, 277
Lip, cleft, 141, 151, 152
Lipid profile, 104, 112
Lumbar puncture, 117, 125, 126, 291, 308
Lumbar spine, 207, 218
Lung transplant, double, 52, 62
Lymphoma, non-Hodgkin, 118, 123, 126, 132
M
Malformation, 282
Malpractice, 247, 259
Management, 239–261
Mantoux test, 305
Maple syrup urine disease, 30, 41
Maslow’s Hierarchy of Needs, 244, 256
Masturbation, 35, 48
Maternal education, 6, 15
Maternal hepatitis B antigen, 31, 32, 42, 43
Medical records, 242, 253
Medication administration
albuterol inhaler, 54, 65
eardrops, 268, 276
eye ointment, 268, 276
intramuscular injections, 6, 15, 180, 191
nasal drops, 268, 276
in toddlers, 34, 47
Medication errors, 247, 260
Medullary cavity, 225, 234
Meningitis
bacterial, 28, 37, 77, 86
cerebrospinal fluid findings in, 77, 86
complications of, 292, 309
generalized tonic-clonic seizure associated with, 78, 87
parent teaching and education about, 292, 309
323
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priority of care for, 77, 86
reflexes associated with, 77, 86
Mental retardation, 205, 216
Mentor, 242, 252
Mesna (Mesnex), 266, 274
Metformin, 185, 197
Methotrexate, 227
Metoclopramide, 266, 274
Minimal change nephrotic syndrome, 159, 160, 168, 169
Mitral regurgitation, 288, 304
Mitrofanoff procedure, 287, 302
Mononucleosis, 55, 66
Montelukast, 290, 306, 307
Moro reflex, 281, 296
Morphine sulfate, 118, 126, 244, 256, 264, 272
Motor vehicle accident, 76, 80, 84, 85, 90, 94
Munchausen syndrome by proxy, 35, 47–48
Murmurs, 99, 106, 288, 304
Muscular disorders, 199–218
Muscular dystrophy
Duchenne, 200, 209
genetic screening for, 200, 210
parent teaching and education about, 201, 210
in preschoolers, 200, 209
pseudohypertrophic, 200, 209
in school-age child, 200, 210
signs of, 200, 210
Myasthenia gravis, 206, 217, 218
Myelomeningocele. See also Spina bifida
Arnold-Chiari malformation associated with, 287, 303
definition of, 81, 90
folic acid intake during pregnancy, 287, 302
head circumference measurements in, 81, 91
hydrocephalus with, 203, 213, 214
in infants, 202, 212
latex allergies associated with, 102, 110
long-term complication of, 81, 91
Mitrofanoff procedure for, 287
in newborn, 76, 81, 85, 90, 202, 212, 213
plan of care for, 81, 91, 202, 212
postoperative plan of care for, 82, 91
priority nursing diagnosis for, 202, 213
surgical repair of, 76, 82, 85, 91, 203, 213
tethered cord, 202, 212
Myoclonic seizures, 293, 310
Myxedema, 179, 189, 190
N
Narcotics, 268, 276
Nasal drops, 268, 276
Nasopharyngitis, 53, 58, 63, 70, 268, 276
Native American culture, 283
Nausea and vomiting, 117, 120, 126, 130
Near drowning, 33, 45
Nebulizer, 248, 261
Necrotizing enterocolitis, 145, 155
Neupogen. See Filgrastim
Neuroblastoma, 83, 84, 93, 94, 120, 123, 129, 133
Neurogenic bladder, 81, 91
Neurological disorders, 75–95
Neurological status assessments, 201, 211
Neuromuscular disorders, 199–218
Neurovascular integrity, 32, 44
Neutropenia, 120, 129, 225, 234
Newborn. See also Infant
anorectal malformation in, 144, 154
bacterial meningitis in, 28, 37
cystic fibrosis in, 29, 39
feeding of, 136, 146
galactosemia in, 29, 40–41
immunizations for, 7, 16
injury prevention for, 32, 43
myelomeningocele in, 76, 81, 85, 90, 202, 212, 213
screening tests for, 281, 296
terminally ill, 295, 312
vital signs in, 7, 17
weight loss in, 6, 16
Nighttime bottles, 285, 301
Nissen fundoplication, 139, 149
Non-Hodgkin lymphoma, 118, 123, 126, 132
Nonsteroidal anti-inflammatory drugs, 227, 236
Norwood procedure, 102, 109
NPH insulin, 264, 
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